Hospital-based palliative care may reduce ICU use

Implementation of palliative care services versus no implementation was associated with a 10% reduction in ICU use during terminal hospitalizations, a study found.

Implementation of a hospital-based palliative care program appeared to modestly decrease intensive care unit (ICU) use during terminal hospitalizations.

Researchers performed a cohort study using data from 51 hospitals in New York State that did or did not start a palliative care program between 2008 and 2014. Study participants were adult patients who died during hospitalization. The study's main outcome measure was ICU use, and a difference-in-differences analysis was used to assess the association between implementation of a palliative care program and ICU use during terminal hospitalizations. Data were adjusted for patient and hospital characteristics and for time trends. Results were published Jan. 8 by JAMA Network Open.

Of the 51 included hospitals, 24 implemented a palliative care program during the study period and 27 had no program. Eighty-three hospitals that had palliative care programs during the entire study period were excluded. A total of 73,370 patients died during hospitalization. The mean age was 76.5 years, and 52.4% were women. Of these 73,370 patients, 37,628 (51.3%) were cared for at hospitals that started palliative care services and 35,742 (48.7%) were cared for at hospitals that did not. In the implementing hospitals, 17,146 study patients (45.6%) received care before the palliative care program began and 20,482 (54.5%) received care afterward.

Patients who received care after a hospital implemented palliative care services were less likely to receive intensive care than those cared for at the same hospital before palliative care services were started (49.3% vs. 52.8%; difference, 3.5% [95% CI, 2.5% to 4.5%]; P<0.001). Implementing palliative care services was associated with a 10% reduction in ICU use during terminal hospitalizations versus no implementation of palliative care (adjusted relative risk, 0.90; 95% CI, 0.85 to 0.95; P<0.001). Implementation of palliative care was not associated with significant differences in length of stay or use of dialysis or with differences in ICU days or use of mechanical ventilation among patients admitted to the ICU.

The authors noted that their data could be affected by residual confounding and that most hospitals were excluded from the study because they already had palliative care programs in place, among other limitations. They concluded that their findings indicate a modest decrease in ICU use during terminal hospitalizations at hospitals that have implemented palliative care programs and that this association could differ according to hospital characteristics.

“Future work should focus on identifying characteristics associated with the effectiveness of palliative care programs in decreasing treatment intensity,” the authors wrote.