Reduction of healthcare costs by implementing palliative family conference with the decision to withdraw life-sustaining treatments

• Main Authors: Hou-Tai Chang, Jih-Shuin Jerng, Duan-Rung Chen
• Format: Article
• Language: English
• Published: Elsevier 2020-01-01
• Series: Journal of the Formosan Medical Association
• Online Access: http://www.sciencedirect.com/science/article/pii/S0929664618306776

Background: Evidence regarding the impact of early palliative family conferences (PFCs) and decision to withdraw life-sustaining treatment (DTW) on healthcare costs in an intensive care unit (ICU) setting is inconsistent. Methods: We retrospectively analyzed patients who died in an ICU from 2013 to 2016. PFCs held within 7 days after ICU admission and DTWs were verified by reviewing medical records and claims data. Comparisons were first made between patients with and without DTWs, and secondly, between DTW patients with and without PFCs within 7 days. Propensity score matching methods were used to examine the difference in costs between patients with and without DTWs and PFCs within 7 days. Results: Of the 579 patients included, those with DTWs (n = 73) had a longer ICU stay than those without (n = 506) (12.9 ± 7.1 vs. 8.4 ± 9.6 days, p < 0.001). The DTW patients were more likely to have a “do-not-resuscitate” order (p < 0.001) and PFCs within 7 days (p < 0.001) and had lower healthcare costs (USD 7358 ± 4116 vs. 8669 ± 9,535, p = 0.038). After matching, healthcare cost reduction for patients with DTWs, compared with those without DTWs, was USD 3467 [95% CI, 915–6019] (p < 0.001). Compared with DTW patients without PFCs within 7 days, the costs for DTW patients with PFCs within 7 days further reduced to USD 3042 [95%CI, 1358–4725] (p < 0.001). Conclusion: Palliative family conferences held within 7 days after ICU admission with decisions to withdraw life-sustaining treatments significantly lowered healthcare costs. Keywords: Family meeting, Healthcare costs, Propensity score matching, Withdrawal of life-sustaining treatments