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Doctor examines patient
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Credit: NCI

A “co-rounding” partnership between medical oncologists and palliative care specialists has shown improvements in health-system and patient-related outcomes.

The first year of the partnership, which was tested in Duke University Hospital’s solid tumor oncology unit, brought significant decreases in the average length of hospital stay and in readmission rates, compared to a previous year in which the partnership did not exist.

There was a decrease in intensive care unit transfers and a trend toward increased hospice referrals as well, although these differences were not significant.

“The integration of palliative care, as a necessary and essential component of cancer care, is one that has been increasingly endorsed,” said Richard Riedel, MD, of Duke University Hospital in Durham, North Carolina.

“The benefits of palliative care have been shown in the outpatient and consultative settings, but we didn’t know its impact on daily inpatient care. Now, we have successfully partnered with our palliative care colleagues to bring their unique skill sets and expertise directly to our admitted patients, and have shown it to be beneficial.”

Dr Riedel described this research (abstract 3*) in a presscast prior to the 2014 Palliative Care in Oncology Symposium, which is scheduled to take place October 24-25 at the Westin Boston Waterfront in Boston.

The co-rounding partnership involves 3 formal meetings each day in which members of the team, including both the attending medical oncologist and the attending palliative care physician, discuss all patients in the solid tumor unit.

The team decides which attending physician oversees direct care for a patient depending on his or her needs. For example, patients with higher symptom burden are typically assigned to the palliative care specialists.

The hospital support staff (eg, internal medicine house staff, physician assistants, and pharmacists) round with both attending physicians, and this care model allows for both formal and informal consultation between specialties.

To evaluate the effects of this model, the researchers assessed outcomes among the 731 patients admitted before the intervention began and 783 admitted in the first year of the intervention. About three-quarters of patients in both groups had metastatic cancer.

The team found a significant decrease in the average length of hospital stay from the pre-intervention period to the post-intervention period—4.51 days and 4.16 days, respectively (P=0.02).

Likewise, there was a significant decrease in readmission rates. There was 23% relative reduction in 7-day readmission rates (P<0.0001) and a 12% relative reduction in 30-day readmission rates (P=0.048).

Patient transfers to the intensive care unit decreased by 15% post-intervention, and hospice referrals increased by 17%, but these effects were not statistically significant (P=0.64 and 0.09, respectively).

The researchers said these results emphasize the value of implementing palliative medicine soon after a cancer diagnosis, rather than waiting until later in the disease’s progression.

Due to positive results with the co-rounding partnership, Duke University Hospital has established new outpatient palliative care clinics in oncology and general medicine.

The researchers are planning future studies to assess longer-term effects of the intervention on both patient and health-system outcomes, evaluate patient satisfaction, and explore potential cost savings associated with this intervention. ht-logo-end

*Data presented differ from data in the abstract.


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