Characteristics associated with higher cost per day or longer length of stay in hospitalized patients who died during the hospitalization or were discharged to hospice

Background: Palliative care has been recommended as an approach to improve the quality of care for patients with advanced illness, while achieving hospital cost savings. However, studies are lacking that identify hospitalized patients who are more likely to have higher cost per day or length of stay (LOS) who may benefit from palliative care consultation.

Objective: Identify characteristics associated with higher cost per day or longer LOS in hospitalized patients at the end of life--those likely to benefit from palliative care consultation.

Design: Observational study.

Setting: Academic medical center.

Patients: Adult inpatients who died during the hospitalization or were discharged to hospice.

Intervention: None.

Measurements: We hypothesized that several patient characteristics would be associated with higher cost per day and/or longer LOS. Using administrative data, we developed univariate and multivariate models to evaluate association between these patient characteristics and cost per day and LOS.

Results: Patients cared for on the cardiothoracic surgery service had significantly higher cost per day ($12,937; P < 0.0001) and LOS (7.0 days; P = 0.001). Neurosurgery patients also had higher cost per day ($2255; P = 0.03), and surgical oncology patients had a longer length of stay (5.3 days; P = 0.003). 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.

Conclusions: Our data suggest that younger patients and those cared for by surgical specialty services may receive the most benefit from palliative care consultation, a finding that needs to be corroborated in other centers.