Impact of Palliative Care Case Management on Resource Use by Patients Dying of Cancer at a Veterans Affairs Medical Center

Abstract

Background: The VA Puget Sound Health Care System (VAPSHCS) started a palliative care service (PCS) in October 2001 to provide case management for patients with advanced cancer. Objective: To examine resource use during the last 60 days of life for patients dying of cancer who received PCS compared to patients receiving usual care (non-PCS) during the same time period. Design: Retrospective nonrandomized comparison of resource use using administrative data. Setting: Tertiary care Veterans Affairs medical center. Participants: All patients who died of cancer between October 1, 2001 and October 31, 2002 at VAPSHCS. Results: Two hundred sixty-five patients died of cancer during the specified time period, including 82 PCS and 183 non-PCS patients. PCS patients received case management for a mean of 79 days, and were younger, had more comorbid conditions, and were more likely to have had chemotherapy in the last 60 days of life than non-PCS patients. Variables associated with more acute care bed days in the last 60 days of life included: chemotherapy in the last 60 days of life, and a length of stay on PCS less than 60 days. Variables associated with fewer acute care bed days within the last 60 days of life included: being married, and a length of stay on PCS 60 days or more. Compared to non-PCS patients, the place of death for PCS patients was less likely to be acute care. Conclusion: PCS for 60 or more days prior to death was associated with decreased use of acute care hospital resources for patients dying of cancer.