Clinical question: Does proactive home- and clinic-based palliative care impact hospital use and health care cost in Medicare Advantage beneficiaries?

Background: Studies demonstrate that community-based palliative care is becoming more common because of the need to better deliver individualized care, the positive effects on patient experience and outcomes, and payment model changes exerting pressure to reduce hospital use and cost.

Study design: Observational, retrospective study using propensity-based matching.

Setting: Southern California Health System.

Synopsis: Using the health systems’ databases of 368 community-based palliative care participants compared with 1,075 matched, non–palliative care individuals, this study showed that community-based palliative care participants had less hospital use and lower hospital costs than did the non–palliative care participants, which drove lower overall health care costs.

Hospitalists managing patients with acute exacerbations of chronic diseases and cancer should consider referral to ambulatory palliative care or comprehensive transitional care programs.

Bottom line: Proactive, ambulatory patient-centered palliative care lowers hospitalizations and end-of-life care costs.

Citations: Cassel JB, Kerr KM, McClish DK, et al. Effect of a Home-Based Palliative Care Program on Healthcare Use and Costs. J Am Geriatr Soc. 64:2288-2295, 2016.

Dr. McAllister is a hospitalist, assistant professor of medicine, and medical director of transitional care in the Department of Hospital Medicine at Cooper University Hospital, Camden, N.J.