Effect of Palliative Care Consults on Acute Care Use for Residents with Dementia in Nursing Homes

This research aimed to understand whether palliative care (PC) consults received by nursing home (NH) residents with dementia affect acute care use. Two providers of PC consults in 46 NHs in 2 states identified NH consult recipients between 2005 and 2010. We merged these data with Medicare resident assessment and claims data to identify dementia and death between 2006 and 2010. Two analytic groups represented the time between first consult and death: ≤ 30 and 31-180 days. Three controls for each consult decedent were selected using propensity score matching with replacement. Weighted multivariate logistic regressions determined the effect of PC consults on hospital death, and in the last 30 days of life, on any hospital or ER use. Residents with consults within 30 days of death (compared to controls) had a significantly lower likelihood of hospital death (AOR 0.04; 95% CI 0.007, 0.196). Those with consults in the last 31-180 days of life (compared to controls) had a significantly lower likelihood of hospital death (AOR 0.006; 95% CI 0.000, 0.170), and in the last 30 days of life, hospitalization (AOR 0.15; 95% CI 0.056, 0.387) and ER use (AOR 0.18; 95% CI 0.046, 0.682). Consults extend PC access to NH residents, which is especially important for residents with dementia for whom the Medicare required six-month terminal prognosis impedes timely hospice enrollment. Medicare reimbursement policies supporting the provision of PC consults are needed to incentivize provider participation in this (currently unprofitable) PC model. Such policy could potentially result in Medicare savings.