Survival, mortality, and location of death for patients seen by a hospital-based palliative care team

Erik Fromme, Paul B. Bascom, M. D. Smith, Susan Tolle, Lissi Hanson, David H. Hickam, Molly Osborne

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background: Little is known about patient outcomes after discharge planning by inpatient palliative care teams. A major difficulty is that successful discharge planning often effectively limits or ends the team's relationship with the patient and family. The goal of this study was to gather a clearer picture of what happened to our palliative care consult patients after discharge. Methods: This was a longitudinal survey of all patients seen over a one year period by the inpatient palliative care team at Oregon Health & Science University (OHSU). Data were recorded by team members at the time of consultation and supplemented by data from administrative databases and death certificates. Results: The team provided consults to 292 unique patients: 60% were younger than age 65, 39% were female, and 16% were members of an ethnic or racial minority. Almost three quarters of patients carried a non-cancer diagnosis. Of the 292 patients, 37% died in hospital and 63% were discharged alive, either to home (54%), nursing facilities (20%), or inpatient hospice (26%). Of the 183 patients discharged alive, 38% died within 2 weeks, 32% died between 2 weeks and 6 months, 25% were alive at 6 months, and 4% were unknown. Of note, only 10% of patients seen by the consult service were readmitted to OSHU within 30 days, and only 5% of those discharged alive from OHSU ultimately died in an acute care hospital. Discussion: We characterized patient outcomes following inpatient palliative care consultation: where patients are discharged, how long they live, and where they die. Two thirds of patients were able to be discharged, even when death occurred within two weeks. The low rates of readmission and death in an acute care hospital support that the decision to discharge the patients was reasonable and the discharge plan was adequate. Hospital based palliative care teams can play an important and unique role in discharge planning-allowing even patients very near death to leave the hospital if they wish.

Original languageEnglish (US)
Pages (from-to)903-911
Number of pages9
JournalJournal of Palliative Medicine
Volume9
Issue number4
DOIs
StatePublished - Aug 2006

Fingerprint

Palliative Care
Survival
Mortality
Patient Discharge
Inpatients
Referral and Consultation
Home Nursing
Hospices
Death Certificates
Longitudinal Studies
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Survival, mortality, and location of death for patients seen by a hospital-based palliative care team. / Fromme, Erik; Bascom, Paul B.; Smith, M. D.; Tolle, Susan; Hanson, Lissi; Hickam, David H.; Osborne, Molly.

In: Journal of Palliative Medicine, Vol. 9, No. 4, 08.2006, p. 903-911.

Research output: Contribution to journalArticle

Fromme, Erik ; Bascom, Paul B. ; Smith, M. D. ; Tolle, Susan ; Hanson, Lissi ; Hickam, David H. ; Osborne, Molly. / Survival, mortality, and location of death for patients seen by a hospital-based palliative care team. In: Journal of Palliative Medicine. 2006 ; Vol. 9, No. 4. pp. 903-911.
@article{4bbdc284827d4cbea5145fbe7f1772a4,
title = "Survival, mortality, and location of death for patients seen by a hospital-based palliative care team",
abstract = "Background: Little is known about patient outcomes after discharge planning by inpatient palliative care teams. A major difficulty is that successful discharge planning often effectively limits or ends the team's relationship with the patient and family. The goal of this study was to gather a clearer picture of what happened to our palliative care consult patients after discharge. Methods: This was a longitudinal survey of all patients seen over a one year period by the inpatient palliative care team at Oregon Health & Science University (OHSU). Data were recorded by team members at the time of consultation and supplemented by data from administrative databases and death certificates. Results: The team provided consults to 292 unique patients: 60{\%} were younger than age 65, 39{\%} were female, and 16{\%} were members of an ethnic or racial minority. Almost three quarters of patients carried a non-cancer diagnosis. Of the 292 patients, 37{\%} died in hospital and 63{\%} were discharged alive, either to home (54{\%}), nursing facilities (20{\%}), or inpatient hospice (26{\%}). Of the 183 patients discharged alive, 38{\%} died within 2 weeks, 32{\%} died between 2 weeks and 6 months, 25{\%} were alive at 6 months, and 4{\%} were unknown. Of note, only 10{\%} of patients seen by the consult service were readmitted to OSHU within 30 days, and only 5{\%} of those discharged alive from OHSU ultimately died in an acute care hospital. Discussion: We characterized patient outcomes following inpatient palliative care consultation: where patients are discharged, how long they live, and where they die. Two thirds of patients were able to be discharged, even when death occurred within two weeks. The low rates of readmission and death in an acute care hospital support that the decision to discharge the patients was reasonable and the discharge plan was adequate. Hospital based palliative care teams can play an important and unique role in discharge planning-allowing even patients very near death to leave the hospital if they wish.",
author = "Erik Fromme and Bascom, {Paul B.} and Smith, {M. D.} and Susan Tolle and Lissi Hanson and Hickam, {David H.} and Molly Osborne",
year = "2006",
month = "8",
doi = "10.1089/jpm.2006.9.903",
language = "English (US)",
volume = "9",
pages = "903--911",
journal = "Journal of Palliative Medicine",
issn = "1096-6218",
publisher = "Mary Ann Liebert Inc.",
number = "4",

}

TY - JOUR

T1 - Survival, mortality, and location of death for patients seen by a hospital-based palliative care team

AU - Fromme, Erik

AU - Bascom, Paul B.

AU - Smith, M. D.

AU - Tolle, Susan

AU - Hanson, Lissi

AU - Hickam, David H.

AU - Osborne, Molly

PY - 2006/8

Y1 - 2006/8

N2 - Background: Little is known about patient outcomes after discharge planning by inpatient palliative care teams. A major difficulty is that successful discharge planning often effectively limits or ends the team's relationship with the patient and family. The goal of this study was to gather a clearer picture of what happened to our palliative care consult patients after discharge. Methods: This was a longitudinal survey of all patients seen over a one year period by the inpatient palliative care team at Oregon Health & Science University (OHSU). Data were recorded by team members at the time of consultation and supplemented by data from administrative databases and death certificates. Results: The team provided consults to 292 unique patients: 60% were younger than age 65, 39% were female, and 16% were members of an ethnic or racial minority. Almost three quarters of patients carried a non-cancer diagnosis. Of the 292 patients, 37% died in hospital and 63% were discharged alive, either to home (54%), nursing facilities (20%), or inpatient hospice (26%). Of the 183 patients discharged alive, 38% died within 2 weeks, 32% died between 2 weeks and 6 months, 25% were alive at 6 months, and 4% were unknown. Of note, only 10% of patients seen by the consult service were readmitted to OSHU within 30 days, and only 5% of those discharged alive from OHSU ultimately died in an acute care hospital. Discussion: We characterized patient outcomes following inpatient palliative care consultation: where patients are discharged, how long they live, and where they die. Two thirds of patients were able to be discharged, even when death occurred within two weeks. The low rates of readmission and death in an acute care hospital support that the decision to discharge the patients was reasonable and the discharge plan was adequate. Hospital based palliative care teams can play an important and unique role in discharge planning-allowing even patients very near death to leave the hospital if they wish.

AB - Background: Little is known about patient outcomes after discharge planning by inpatient palliative care teams. A major difficulty is that successful discharge planning often effectively limits or ends the team's relationship with the patient and family. The goal of this study was to gather a clearer picture of what happened to our palliative care consult patients after discharge. Methods: This was a longitudinal survey of all patients seen over a one year period by the inpatient palliative care team at Oregon Health & Science University (OHSU). Data were recorded by team members at the time of consultation and supplemented by data from administrative databases and death certificates. Results: The team provided consults to 292 unique patients: 60% were younger than age 65, 39% were female, and 16% were members of an ethnic or racial minority. Almost three quarters of patients carried a non-cancer diagnosis. Of the 292 patients, 37% died in hospital and 63% were discharged alive, either to home (54%), nursing facilities (20%), or inpatient hospice (26%). Of the 183 patients discharged alive, 38% died within 2 weeks, 32% died between 2 weeks and 6 months, 25% were alive at 6 months, and 4% were unknown. Of note, only 10% of patients seen by the consult service were readmitted to OSHU within 30 days, and only 5% of those discharged alive from OHSU ultimately died in an acute care hospital. Discussion: We characterized patient outcomes following inpatient palliative care consultation: where patients are discharged, how long they live, and where they die. Two thirds of patients were able to be discharged, even when death occurred within two weeks. The low rates of readmission and death in an acute care hospital support that the decision to discharge the patients was reasonable and the discharge plan was adequate. Hospital based palliative care teams can play an important and unique role in discharge planning-allowing even patients very near death to leave the hospital if they wish.

UR - http://www.scopus.com/inward/record.url?scp=33747872048&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33747872048&partnerID=8YFLogxK

U2 - 10.1089/jpm.2006.9.903

DO - 10.1089/jpm.2006.9.903

M3 - Article

C2 - 16910805

AN - SCOPUS:33747872048

VL - 9

SP - 903

EP - 911

JO - Journal of Palliative Medicine

JF - Journal of Palliative Medicine

SN - 1096-6218

IS - 4

ER -