Evidence map›Paper›PMID 33849539›Full record

ArticleBMC health services research2021

The association between varying levels of palliative care involvement on costs during terminal hospitalizations in Canada from 2012 to 2015.

Sarina R Isenberg, Christopher Meaney, Peter May, Peter Tanuseputro, Kieran Quinn, Danial Qureshi, Stephanie Saunders, Colleen Webber, Hsien Seow, James Downar and 7 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05806255 (Remote Self-Reporting of Symptoms by Patients With Palliative Care Needs), which is not on this map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05806255 naunknown statusnot on this mapstarted 2024, after this paper: background citation

Remote Self-Reporting of Symptoms by Patients With Palliative Care Needs (RELIEF): A Mixed-Methods Implementation Study

TypeinterventionalSponsorWilliam Osler Health SystemRan2024 to 2025Enrolled600ConditionsPalliative CareArmsThe RELIEF App
3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Sarina R IsenbergBruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada. sisenberg@bruyere.org.ORCID http://orcid.org/0000-0001-6059-5366
Christopher MeaneyDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada.
Peter MayCentre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.
Peter TanuseputroBruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.
Kieran QuinnInstitute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
Danial QureshiBruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.
Stephanie SaundersTemmy Latner Centre for Palliative Care, Sinai Health, Toronto, Canada.
Colleen WebberBruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.
Hsien SeowDepartment of Oncology, McMaster University, Hamilton, Canada.
James DownarBruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.
Thomas J SmithDepartment of Medicine, Johns Hopkins Hospital and Health System, Baltimore, USA.
Amna HusainDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada.
Peter G LawlorBruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.
Rob FowlerInstitute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
Julie LachanceEnd-of-Life Care Unit, Strategic Policy Branch, Health Canada, Ottawa, Canada.
Kimberlyn McGrailCentre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, Canada.
Amy T HsuBruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.

Funding

ANDROGEN REGULATION OF HUMAN SEBACEOUS GLANDSK08AR002018 · NIAMS · PENNSYLVANIA STATE UNIV HERSHEY MED CTR · PI THIBOUTOT, DIANE M. · 1997 to 2001
$225k
CIHR CIHR SDA-156943Health Research Board in Ireland ARPP-A-2018-005
6 · The paper itself

Abstract

backgroundInpatient palliative care is associated with lower inpatient costs; however, this has yet to be studied using a more nuanced, multi-tiered measure of inpatient palliative care and a national population-representative dataset. Using a population-based cohort of Canadians who died in hospital, our objectives were to: describe patients' receipt of palliative care and active interventions in their terminal hospitalization; and examine the relationship between inpatient palliative care and hospitalization costs.

methodsRetrospective cohort study using data from the Discharge Abstract Database in Canada between fiscal years 2012 and 2015. The cohort were Canadian adults (age ≥ 18 years) who died in hospital between April 1st, 2012 and March 31st, 2015 (N = 250,640). The exposure was level of palliative care involvement defined as: medium-high, low, or no palliative care. The main measure was acute care costs calculated using resource intensity weights multiplied by the cost of standard hospital stay, represented in 2014 Canadian dollars (CAD). Descriptive statistics were represented as median (IQR), and n(%). We modelled cost as a function of palliative care using a gamma generalized estimating equation (GEE) model, accounting for clustering by hospital.

resultsThere were 250,640 adults who died in hospital. Mean age was 76 (SD 14), 47% were female. The most common comorbidities were: metastatic cancer (21%), heart failure (21%), and chronic obstructive pulmonary disease (16%). Of the decedents, 95,450 (38%) had no palliative care involvement, 98,849 (38%) received low involvement, and 60,341 (24%) received medium to high involvement. Controlling for age, sex, province and predicted hospital mortality risk at admission, the cost per day of a terminal hospitalization was: $1359 (95% CI 1323: 1397) (no involvement), $1175 (95% CI 1146: 1206) (low involvement), and $744 (95% CI 728: 760) (medium-high involvement).

conclusionsIncreased involvement of palliative care was associated with lower costs. Future research should explore whether this relationship holds for non-terminal hospitalizations, and whether palliative care in other settings impacts inpatient costs.

Indexed as

Palliative CareTerminal CareAdolescentAdultAgedCanadaFemaleHospitalizationHumansLength of StayMaleRetrospective StudiesAcute care costsEnd of lifePalliative careTerminal hospitalizations

Identifiers

PMID33849539
PMCPMC8045222

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.