Engineers often quip that ‘better, faster, cheaper’ is a choose two trilemma.
Project managers quip that ‘on time, on budget and on-spec’ is also a choose two trilemma.
Duke seems to be showing a better, safer and cheaper method of approaching some cancer care cases.
Duke University Medical System studied how providing pallative care to oncology patients changed care decisions and outcomes. The results were significant.
The study reviewed 2,353 inpatient encounters that included palliative care physicians, who focus on alleviating pain, side effects, and improving quality of life for patients and their families during serious illness. After the model was implemented at Duke in 2011, the analysis showed, there was a 23-percent decrease in the number of patients readmitted to the hospital within a week of discharge. Patient transfers to the intensive care unit also decreased by 15 percent, and patients were discharged from the hospital about eight hours sooner, on average. During the same time, hospice referrals increased by 17 percent.
From an insurance and cost point of view, anything that can be done to avoid intensive care unit admissions is probably a massive net cost savings. Readmissions for problems within a week of discharge is a massive red flag for quality of care concerns as well. The Center for Medicare and Medicaid is penalizing hospitals for readmissions thirty days after discharge, so a week is an indicator of a potential problem.
Duke is not using capital intensive super high technology to reduce costs. They are having highly trained people talk to patients, ask them what they want, how they are feeling, and then devising plans to make them feel better while achieving their goals. It is a shocking system change. Talking works.
There is significant evidence that when people feel that they have control and input over their medical decisions, they tend to use less intensive services as their goals are not always survival at any cost nor effort. Some may want that. Others may want to feel good for as long as possible and then be willing to accept death if they are in their homes with loved ones. Others will want something in between. The medical system seldom asks what end goals are, and suffering is prolonged while costs are accumulated.
Follow-up 1: A valued commenter passed along a fascinating review of pallative care for advanced oncology patients at non-Duke locations. It was a good lunch time read.