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Improvements in Patient and Health System Outcomes Using an Integrated Oncology and Palliative Medicine Approach on a Solid Tumor Inpatient Service.

Publication ,  Journal Article
Riedel, RF; Slusser, K; Power, S; Jones, CA; LeBlanc, TW; Kamal, AH; Desai, D; Allen, D; Yu, Y; Wolf, S; Galanos, AN
Published in: J Oncol Pract
September 2017

PURPOSE: Early palliative care (PC) improves outcomes for outpatients with advanced cancer. Its effect on hospitalized patients with cancer is unknown. Herein, we report on the influence of a novel, fully integrated inpatient medical oncology and PC partnership at a tertiary medical center during its first year of implementation. METHODS: We conducted a retrospective, longitudinal, pre- and postintervention cohort study at Duke University Hospital. Pre- and postintervention cohorts were defined as all patients admitted to the solid tumor inpatient service from September 1, 2009, to June 30, 2010, and September 1, 2011 to June 30, 2012, respectively. We extracted patient data, including demographics, cancer diagnosis, disease status, length of stay, intensive care unit transfer rate, discharge disposition, time to emergency department return, time to readmission, and 7- and 30-day emergency department return and readmission rates. Nursing and physician surveys assessed satisfaction. Descriptive statistics, and Kruskal-Wallis and Χ2 tests were used to describe and compare cohorts. A generalized estimating equation accounted for repeated measures. RESULTS: Pre- and postintervention analysis cohorts included 731 and 783 patients, respectively, representing a total of 1,514 patients and 2,353 encounters. Cohorts were similar in baseline characteristics. Statistically significant lower odds in 7-day readmission rates were observed in the postintervention cohort (adjusted odds ratio, 0.76; 95% CI, 0.58 to 1.00; P = .0482). Patients in the postintervention group had a decrease in mean length of stay (-0.30 days; 95% CI, -0.62 to 0.02); P = .0651). We observed a trend for increasing hospice referrals ( P = .0837) and a 15% decrease in intensive care unit transfers ( P = .61). Physicians and nurses universally favored the model. CONCLUSION: A fully integrated inpatient partnership between PC and medical oncology is associated with significant and clinically meaningful improvements in key health system-related outcomes and indicators of quality cancer care.

Duke Scholars

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Published In

J Oncol Pract

DOI

EISSN

1935-469X

Publication Date

September 2017

Volume

13

Issue

9

Start / End Page

e738 / e748

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Patients
  • Patient Discharge
  • Palliative Medicine
  • Oncology & Carcinogenesis
  • Neoplasms
  • Middle Aged
  • Medical Oncology
  • Male
  • Length of Stay
 

Citation

APA
Chicago
ICMJE
MLA
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Riedel, R. F., Slusser, K., Power, S., Jones, C. A., LeBlanc, T. W., Kamal, A. H., … Galanos, A. N. (2017). Improvements in Patient and Health System Outcomes Using an Integrated Oncology and Palliative Medicine Approach on a Solid Tumor Inpatient Service. J Oncol Pract, 13(9), e738–e748. https://doi.org/10.1200/JOP.2017.022749
Riedel, Richard F., Kim Slusser, Steve Power, Christopher A. Jones, Thomas W. LeBlanc, Arif H. Kamal, Devi Desai, et al. “Improvements in Patient and Health System Outcomes Using an Integrated Oncology and Palliative Medicine Approach on a Solid Tumor Inpatient Service.J Oncol Pract 13, no. 9 (September 2017): e738–48. https://doi.org/10.1200/JOP.2017.022749.
Riedel RF, Slusser K, Power S, Jones CA, LeBlanc TW, Kamal AH, et al. Improvements in Patient and Health System Outcomes Using an Integrated Oncology and Palliative Medicine Approach on a Solid Tumor Inpatient Service. J Oncol Pract. 2017 Sep;13(9):e738–48.
Riedel, Richard F., et al. “Improvements in Patient and Health System Outcomes Using an Integrated Oncology and Palliative Medicine Approach on a Solid Tumor Inpatient Service.J Oncol Pract, vol. 13, no. 9, Sept. 2017, pp. e738–48. Pubmed, doi:10.1200/JOP.2017.022749.
Riedel RF, Slusser K, Power S, Jones CA, LeBlanc TW, Kamal AH, Desai D, Allen D, Yu Y, Wolf S, Galanos AN. Improvements in Patient and Health System Outcomes Using an Integrated Oncology and Palliative Medicine Approach on a Solid Tumor Inpatient Service. J Oncol Pract. 2017 Sep;13(9):e738–e748.

Published In

J Oncol Pract

DOI

EISSN

1935-469X

Publication Date

September 2017

Volume

13

Issue

9

Start / End Page

e738 / e748

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Patients
  • Patient Discharge
  • Palliative Medicine
  • Oncology & Carcinogenesis
  • Neoplasms
  • Middle Aged
  • Medical Oncology
  • Male
  • Length of Stay