Implementation of an integrated respiratory palliative care service for patients with advanced lung disease
Julie McDonald
A B * , David Marco C , Rebecca Howard D , Euan Fox A and Jennifer Weil B C E
+ Author Affiliations
- Author Affiliations
A Respiratory and Sleep Medicine Department, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia.
B Palliative Care Department, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia.
C Centre for Palliative Care, St Vincent’s Hospital Melbourne and University of Melbourne, Fitzroy, Vic. 3065, Australia.
D Health Independence Program, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia.
E Department of Medicine, University of Melbourne, Parkville, Vic. 3052, Australia.
* Correspondence to: Julie.mcdonald@svha.org.au
Australian Health Review 46(6) 713-721 https://doi.org/10.1071/AH22103
Submitted: 23 March 2022 Accepted: 21 September 2022 Published: 13 October 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objectives This study describes the model of care provided by an integrated respiratory and palliative care service for patients with advanced lung disease, and assesses the potential impact of the service on acute hospital utilisation and cost.
Methods This study implemented an integrated specialist care service at a single tertiary teaching hospital in Melbourne, Victoria, Australia. The service provided disease-orientated care, alongside symptom management and advance care planning, and comprised both outpatient clinic (OPC) and home visit (HV) capacity for those with barriers to accessing OPC. Acute hospital utilisation and hospital cost were analysed with a paired t-test 90 days before/after the first physician review.
Results Between April 2017 and 2019, 51 patients received 59 HVs, whereas between July 2018 and 2020, 58 patients received 206 OPC reviews. Acute hospital admissions decreased by 51% in the HV cohort (P < 0.05) and by 46% in the OPC cohort (P = 0.01); total bed days of acute admissions decreased by 29% in the HV cohort (P = n.s.), and by 60% in the OPC cohort (P < 0.05); and specialist outpatient clinic attendances decreased in the OPC cohort by 55% (P < 0.01). There was a decrease in hospital cost for the HV cohort by 3% (cost savings of A$18 579), and in the OPC cohort by 23% (cost savings of A$109 149).
Conclusions This model of care provided specialist respiratory management with seamless integration of palliative care, with the capacity for home visits. There was a decrease in acute hospital utilisation and overall cost savings observed in both HV and OPC cohorts.
Keywords: advance care planning, breathlessness, chronic obstructive pulmonary disease, delivery of health care, hospitalisation, integrated, lung diseases, palliative care.
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