False Assumptions


Hospitalists unfamiliar with palliative care might think that older patients are the ones generating higher costs per day and longer length of stay (LOS). But new research from a fellow hospitalist suggests that's not the case.

A report in this month's Journal of Hospital Medicine found that patients 65 years and older had a significantly lower cost per day ($811; P=0.02) and LOS (-1.8 days; P=0.003) for each decade increase in age (J Hosp Med. 2011;6(6):338-343). The data also show patients on surgical specialty services generate higher costs and higher LOS, a likely nod to the complexity of cases that land on those services, says University of Colorado Denver hospitalist Jean Youngwerth, MD.

"We were anticipating more from the start that patients who were older were going to have higher costs per day and LOS," says Dr. Youngwerth, who also serves as associate program director for the Colorado Palliative Medicine Fellowship and Director of the University of Colorado Hospital Palliative Care Consult Service. "A lot of times, it is younger patients who are the sickest of the sick.

"People will go full force on them and they won't necessarily have a lot of the conversations they'd be having with older patients. The assumption is 'They're young, they shouldn't be dying' … even though they're a very sick person."

Dr. Youngwerth says hospitalists working without the aid of institutional support can still make palliative-care discussions a priority.

"You don't need a specialist for that," she adds, "[for] sitting down and setting goals of care, learning about the person, and then making sure that we're matching what their goals and values are to their plan of care."

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