Self-Reported California Hospital Palliative Care Program Composition, Certification, and Staffing Level Are Associated with Lower End-of-Life Medicare Utilization

摘要

Background: California hospitals report palliative care (PC) program characteristics to the California Office of Statewide Health Planning and Development (OSHPD), but the significance of this information is unknown. Objective: Our objective was to determine whether self-reported California hospital PC program characteristics are associated with lower end-of-life (EoL) Medicare utilization. Design: We performed a cross-sectional study of hospitals submitting 2012 data to OSHPD and included in the 2012 Dartmouth Atlas of Healthcare (DAHC) dataset, using statistical hypothesis testing, multivariate regression, and fuzzy set qualitative comparative analysis. Setting/Subjects: Our analysis included 203 hospitals primarily providing general medical-surgical (GMS) care. Measurements: The following measures were available for each hospital: licensed GMS beds; type of control; presence of an inpatient or outpatient PC program; number of physicians, nurses, social workers, and chaplains on the PC team; number of PC-certified staff; percentage of Medicare decedents dying as inpatients; and average total hospital days, ICU days, and physician visits per Medicare decedent in the last six months of life. Results: Investor-owned hospitals have fewer PC programs and higher EoL utilization than do nonprofit hospitals. Among nonprofit hospitals, small size (substantially fewer than 150 medical-surgical beds), or large size and having an inpatient PC program with more than three PC staff per 100 GMS beds, or an interdisciplinary PC-certified team, is associated with significantly lower EoL hospital utilization and percentage of deaths occurring in the inpatient setting. Discussion: Improved program performance associated with higher staffing levels may be mediated by increased access to and earlier PC interventions. Conclusion: California hospital-reported PC program characteristics are associated with significantly lower inpatient utilization by Medicare decedents.