Early Palliative Care With "Co-Rounding" Model Improves Patient Outcomes

Richard Riedel, MD

A “co-rounding” model partnering medical oncologists with palliative care specialists was associated with improved outcomes at an inpatient oncology unit, according to a retrospective cohort analysis presented at a presscast ahead of the 2014 Palliative Care in Oncology Symposium.

In the study, the average hospital stay was shorter and 7- and 30-day readmission rates were lower for patients receiving the early palliative intervention. Additionally, trends toward increased hospice referrals and decreased ICU transfers were linked to the co-rounding program.

Data support the benefit of early palliative care for patients with advanced cancer in the outpatient setting, according to lead study author Richard Riedel, MD, who presented the results. However, “the benefit of integrated palliative care on an inpatient oncology ward with daily assessments of patients is unknown,” added Riedel, an associate professor of Medicine and Medical Director of the inpatient solid tumor service at Duke University Medical Center, where the co-rounding program was implemented in September 2011.

The program involves 3 daily meetings among each patient’s treatment team, including the attending medical oncologist and attending palliative care physician. The attending responsible for direct patient care is determined by patient need. Rounding includes both of the attending physicians and hospital support staff (eg, hematology/oncology fellow, pharmacist, physician assistant).

The data reported during the presscast were the 1-year results of the program. The outcomes included data from 2353 encounters involving two cohorts: 783 patients in the intervention cohort (admitted/transferred to the inpatient unit between September 2011—June 2012) and 731 patients admitted before the intervention started (September 2009–June 2010).

“The most common diagnoses [in each arm] were lung cancer, breast cancer and colorectal cancer,” said Riedel. Seventy-four percent of patients in the intervention cohort and 73% in the pre-intervention group had advanced cancer (P = .60). All other baseline characteristics were similar, as well, including age (62 vs 61 years; P = .07), race (white: 71% vs 68%; P = .39), gender (male: 48% vs 51%; P = .22), and Medicare recipients (51% vs 49%; P = .36).

The average length of hospital stay was 4.16 days in the intervention group and 4.51 days in the pre-intervention group (P = .02). There was a statistically significant 12% (P = .048) and 23% (P <.0001) reduction in 7- and 30-day readmission rates, respectively, during the intervention period. There was also a nonstatistically significant 15% reduction in ICU transfers (P = 0.64) and a 17% increase in hospice referrals that was also nonsignificant (P = .09).

“Integration of palliative care into oncology is the definition of good oncology care, said presscast moderator Jyoti D Patel, MD, Northwestern University Feinberg School of Medicine, who moderated the presscast. “This novel paradigm of co-rounding certainly has had impressive results in this study.”

Survey data from physicians and nurses who were part of the co-rounding program showed that there was a high level of satisfaction with the palliative intervention model and outcomes, according to Riedel.

The researchers intend to conduct future studies that will evaluate the impact of the palliative intervention over a longer period, determine the cost implications of the early intervention, and assess patient satisfaction with the program.

Riedel RF, Slusser K, Power S, et al. Early palliative care on an inpatient oncology unit: impact of a novel co-rounding partnership on patient and health system outcomes. Presented at: 2014 Palliative Care in Oncology Symposium; October 24-25, 2014; Boston, MA. Abstract 3.

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