A Palliative Radiation Oncology Consult Service Reduces Total Costs During Hospitalization
A Palliative Radiation Oncology Consult Service Reduces Total Costs During Hospitalization
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DOI：
10.1016/j.jpainsymman.2018.03.005
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发表时间：
2018-06-01
影响因子：
4.7
通讯作者：
Dharmarajan, Kavita V.
中科院分区：
文献类型：
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作者：
Chang, Sanders;May, Peter;Dharmarajan, Kavita V.
上下文。姑息性放射治疗（PRT）是缓解骨转移症状的一种非常有效的治疗方法；然而，目前使用的标准分院时间表可能导致昂贵的护理，特别是当患者在住院环境中接受治疗时。姑息性放射肿瘤学咨询（PROC）服务于2013年开发，旨在提高prt的适宜性、及时性和护理价值。我们的主要目的是比较在PROC建立之前或之后接受PRT治疗的两组骨转移住院患者的总成本。其次，我们评估了成本节约的驱动因素，包括住院时间、专科护理姑息服务的利用和PRT计划。2010年至2016年在一家三级医院接受骨转移PRT治疗的患者被纳入我们的观察性队列研究。我们使用倾向评分调整分析比较了总费用和住院时间。采用chi(2)检验和Mann-Whitney U检验比较姑息治疗利用和PRT计划。我们确定了181名住院患者，76名在PROC前治疗，105名在PROC后治疗。PROC前治疗的患者总住院费用中位数为76,792美元（范围为6380- 346,296美元），PROC后治疗的患者总住院费用中位数为50,582美元（范围为7585- 620,943美元）。这相当于总住院费用平均节省20,719美元（95% CI[$3687, $37,750]）。此外，PROC与缩短PRT计划、增加姑息治疗利用率和住院时间减少8.5天相关（95% CI[3.2,14]）。PROC服务是一种整合姑息治疗实践的放射肿瘤学模式，与节省成本、缩短疗程和住院时间以及增加姑息治疗有关。(C) 2018年美国临终关怀与姑息医学学会。Elsevier Inc.出版。版权所有。
Context. Palliative radiation therapy (PRT) is a highly effective treatment in alleviating symptoms from bone metastases; however, currently used standard fractionation schedules can lead to costly care, especially when patients are treated in an inpatient setting. The Palliative Radiation Oncology Consult (PROC) service was developed in 2013 to improve appropriateness, timeliness, and care value from PRT.Objectives. Our primary objective was to compare total costs among two cohorts of inpatients with bone metastases treated with PRT before, or after, PROC establishment. Secondarily, we evaluated drivers of cost savings including hospital length of stay, utilization of specialty-care palliative services, and PRT schedules.Methods. Patients were included in our observational cohort study if they received PRT for bone metastases at a single tertiary care hospital from 2010 to 2016. We compared total costs and length of stay using propensity score-adjusted analyses. Palliative care utilization and PRT schedules were compared by chi(2) and Mann-Whitney U tests.Results. We identified 181 inpatients, 76 treated before and 105 treated after PROC. Median total hospitalization cost was $76,792 (range $6380-$346,296) for patients treated before PROC and $50,582 (range $7585-$620,943) for patients treated after PROC. This amounted to an average savings of $20,719 in total hospitalization costs (95% CI [$3687, $37,750]). In addition, PROC was associated with shorter PRT schedules, increased palliative care utilization, and an 8.5 days reduction in hospital stay (95% CI [3.2,14]).Conclusion. The PROC service, a radiation oncology model integrating palliative care practice, was associated with cost-savings, shorter treatment courses and hospitalizations, and increased palliative care. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.