MAKE THE CASE
APPENDIX ONE: Selected References Describing Palliative Care Impacts
This annotated reference list summarizes key findings from a handful of the hundreds of peer-reviewed studies of the impacts of palliative care. Studies were selected because of the strength of design (randomized trial, well-designed observational study, or systematic review, for example.) Studies that looked at impact across domains—for example, assessing both patient experience and costs of care for the same population—and multi-site studies were also featured. As a body of evidence, these studies demonstrate that palliative care simultaneously improves health, experience, and economic outcomes—the gold standard for quality in health care.
Inpatient Palliative Care: Impacts Across Multiple Domains
Study Characteristics
Patient Experience
Health & Quality
of Life Outcomes
Utilization and Cost Outcomes
Glenn Gade et al., “Impact of an Inpatient Palliative Care Team: A Randomized Controlled Trial,” Journal of Palliative Medicine 11, no. 2 (Mar. 11, 2008): 180-190.
Not assessed in this study.
Palliative care patients reported better experience of care and better communication with care providers.
Inpatient palliative care associated with reduced costs over six months, and longer hospice stays (24 days versus 12).
Sean O'Mahony et al., “The benefits of a hospital-based inpatient palliative care consultation service: preliminary outcome data,” Journal of Palliative Medicine 2005;8(5):1033-1039.
87% of palliative care recipients had improvement in pain or other symptoms.
95% of family caregivers surveyed by phone said they would recommend the palliative care service to others.
Not assessed in this study.
Peter May et al., “Economics of Palliative Care for Hospitalized Adults with Serious Illness: A Meta-Analysis,” JAMA Internal Medicine 178, no. 6 (June 1, 2018): 820–29.
Not assessed in this study.
Not assessed in this study.
Direct costs of hospital care were 28% lower among palliative care recipients, compared to matched patients that did not receive palliative care.
Peter May et al., “Evaluating Hospital Readmissions for Persons with Serious and Complex Illness: A Competing Risks Approach,” Medical Care Research and Review 77, no. 6 (Dec. 1, 2020): 574–83.
Not assessed in this study.
Not assessed in this study.
30-, 60-, and 90-day readmission rates were lower for palliative care patients, compared to matched patients who did not receive palliative care.
R. Sean Morrison et al., “Palliative Care Consultation Teams Cut Hospital Costs for Medicaid Beneficiaries,” Health Affairs (Millwood) 30, no. 3 (Mar. 2011): 454–63.
Not assessed in this study.
Not assessed in this study.
Costs reduced by 11% per case.
Patients dying in intensive care units (ICUs) decreased from 58% to 34%.
Patients discharged to hospice increased from 1% to 30%.
Carin van Zyl et al., “Doing More with the Same: Comparing Public and Private Hospital Palliative Care within California,” Journal of Palliative Medicine. 2022 Jul;25(7):1064-1071
Palliative care teams in both types of hospitals achieved improvements in pain, nausea, dyspnea, and anxiety.
Not assessed in this study.
Not assessed in this study.
Study Characteristics
Patient Experience
Health & Quality
of Life Outcomes
Utilization and Cost Outcomes
Richard Brumley, et al., “Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care,“ J Am Geriatr Soc. 2007 Jul;55(7):993-1000.
Not assessed in this study.
HBPC patients reported greater improvement in satisfaction with care at 30 and 90 days after enrollment.
Overall costs were 33% lower for HBPC patients.
HBPC patients were more likely to die at home, and were less likely to visit the emergency department or be admitted to the hospital.
Christopher W Kerr et al., “Cost savings and enhanced hospice enrollment with a home-based palliative care program implemented as a hospice-private payer partnership,” Journal of Palliative Medicine 2014 Dec;17(12):1328-35.
Not assessed in this study.
Not assessed in this study.
Overall costs for HBPC patients were 36% lower in the final three months of life.
HBPC patients were more likely to enroll in hospice (70% versus 25%) and had longer lengths of stay in hospice (median 34 versus nine days.)
Christopher W Kerr et al., “Clinical impact of a home-based palliative care program: a hospice-private payer partnership,” J Pain Symptom Manage. 2014 Nov;48(5):883-92.e1.
Post-enrollment improvements seen in anxiety, appetite, dyspnea, well-being, depression, and nausea.
Patients, caregivers, and physicians reported high satisfaction (93%-96%) with the program.
HBPC patients had a longer hospice average length of stay of 77.9 days, compared with all other hospice referrals (average length of stay: 56.5 days).
J Brian Cassel, et al., “Effect of a Home-Based Palliative Care Program on Healthcare Use and Costs,” J Am Geriatr Soc. 2016 Nov;64(11):2288-2295
Not assessed in this study.
Not assessed in this study.
Overall costs were 49% - 59% lower depending on the primary disease.
Dana Lustbader et al., “The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization,” Journal of Palliative Medicine 2017 Jan;20(1):23-28.
Not assessed in this study.
Not assessed in this study.
Overall costs for HBPC patients were 37% lower across the final three months of life.
HBPC patients had a higher hospice enrollment rate (57% vs 37%), and a longer median hospice length of service (34 days vs 10 days.)
Keith Kranker et al., “Evaluation of the Medicare Care Choices Model Annual Report 4.” Mathematica report submitted to CMMI April 2022
Net Medicare expenditures were 14% lower for MCCM participants.
MCCM participants had 26% fewer inpatient admissions, 14% fewer outpatient emergency department visits, 38% fewer ICU days, and were 29% more likely to enroll in hospice.
Outpatient/Clinic-Palliative Care: Impacts Across Multiple Domains
Study Characteristics
Patient Experience
Health & Quality
of Life Outcomes
Utilization and Cost Outcomes
Brian Cassel et al., “Early palliative care for patients with solid tumors and hematological malignancies: Impact on quality metrics and costs of care,” Supportive Care in Cancer 25, suppl. 2 (Apr 22, 2017): 185-185.
Not assessed in this study.
Not assessed in this study.
Late-palliative care patients were 4.8 times more likely to be admitted to the hospital in the final 30 days of life, and 4.2 times more likely to die in the hospital.
Direct costs of care in the final 30 days of life for the late-palliative care patients were double the costs for early-palliative care patients.
David Hui et al., “Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients,” Cancer120, no. 11 (June 2014): 1743-1749.
Not assessed in this study.
Not assessed in this study.
Earlier palliative care was associated with lower rates of hospitalization, ICU use, and emergency department visits.
Dio Kavalieratos et al., “Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis,” JAMA.2016 Nov 22;316(20):2104-2114.
Palliative care was associated consistently with improvements in advance care planning, quality of life, and symptom burden.
Palliative care was associated consistently with improvements in patient and caregiver satisfaction.
Palliative care was associated consistently with lower health care utilization.
Kieran L. Quinn et al., “Association of Receipt of Palliative Care Interventions With Health Care Use, Quality of Life, and Symptom Burden Among Adults With Chronic Noncancer Illness: A Systematic Review and Meta-analysis,” JAMA.2020 Oct 13;324(14):1439-1450.
Palliative care was associated with lower symptom burden.
Not assessed in this study.
Palliative care was associated with less emergency department use and fewer hospitalizations.
Colin Scibetta et al., “The Costs of Waiting: Implications of the Timing of Palliative Care Consultation among a Cohort of Decedents at a Comprehensive Cancer Center,” Journal of Palliative Medicine 19, no. 1 (Jan. 2016): 69-75.
Not assessed in this study.
Not assessed in this study.
Earlier palliative care was associated with lower rates of hospitalization, ICU use, and emergency department visits in the final month of life.
Inpatient costs for the hospital were 26% lower for the earlier palliative care patients.
Jennifer S. Temel et al., “Early palliative care for patients with metastatic non-small-cell lung cancer,” New England Journal of Medicine 363, no. 8 (Aug 19, 2010): 733-742.
Palliative care recipients had better quality of life and lived longer; fewer had depressive symptoms; fewer had aggressive care at the end of life.
Not assessed in this study.
Not assessed in this study.
Camilla Zimmerman et al., “Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial,” Lancet 383, no. 9930 (May 17, 2014): 1721-1730.
At four months, quality of life and symptom severity improved.
At four months, satisfaction with care improved.
Not assessed in this study.
Study Characteristics
Patient Experience
Health & Quality
of Life Outcomes
Utilization and Cost Outcomes
Richard Brumley, et al., “Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care,“ J Am Geriatr Soc. 2007 Jul;55(7):993-1000.
Not assessed in this study.
HBPC patients reported greater improvement in satisfaction with care at 30 and 90 days after enrollment.
Overall costs were 33% lower for HBPC patients.
HBPC patients were more likely to die at home, and were less likely to visit the emergency department or be admitted to the hospital.
Christopher W Kerr et al., “Cost savings and enhanced hospice enrollment with a home-based palliative care program implemented as a hospice-private payer partnership,” Journal of Palliative Medicine 2014 Dec;17(12):1328-35.
Not assessed in this study.
Not assessed in this study.
Overall costs for HBPC patients were 36% lower in the final three months of life.
HBPC patients were more likely to enroll in hospice (70% versus 25%) and had longer lengths of stay in hospice (median 34 versus nine days.)
Christopher W Kerr et al., “Clinical impact of a home-based palliative care program: a hospice-private payer partnership,” J Pain Symptom Manage. 2014 Nov;48(5):883-92.e1.
Post-enrollment improvements seen in anxiety, appetite, dyspnea, well-being, depression, and nausea.
Patients, caregivers, and physicians reported high satisfaction (93%-96%) with the program.
HBPC patients had a longer hospice average length of stay of 77.9 days, compared with all other hospice referrals (average length of stay: 56.5 days).
J Brian Cassel, et al., “Effect of a Home-Based Palliative Care Program on Healthcare Use and Costs,” J Am Geriatr Soc. 2016 Nov;64(11):2288-2295
Not assessed in this study.
Not assessed in this study.
Overall costs were 49% - 59% lower depending on the primary disease.
Dana Lustbader et al., “The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization,” Journal of Palliative Medicine 2017 Jan;20(1):23-28.
Not assessed in this study.
Not assessed in this study.
Overall costs for HBPC patients were 37% lower across the final three months of life.
HBPC patients had a higher hospice enrollment rate (57% vs 37%), and a longer median hospice length of service (34 days vs 10 days.)
Keith Kranker et al., “Evaluation of the Medicare Care Choices Model Annual Report 4.” Mathematica report submitted to CMMI April 2022
Net Medicare expenditures were 14% lower for MCCM participants.
MCCM participants had 26% fewer inpatient admissions, 14% fewer outpatient emergency department visits, 38% fewer ICU days, and were 29% more likely to enroll in hospice.
Home-Based Palliative Care: Impacts Across Multiple Domains
Study Characteristics
Patient Experience
Health & Quality
of Life Outcomes
Utilization and Cost Outcomes
Richard Brumley, et al., “Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care,“ J Am Geriatr Soc. 2007 Jul;55(7):993-1000.
Not assessed in this study.
HBPC patients reported greater improvement in satisfaction with care at 30 and 90 days after enrollment.
Overall costs were 33% lower for HBPC patients.
HBPC patients were more likely to die at home, and were less likely to visit the emergency department or be admitted to the hospital.
Christopher W Kerr et al., “Cost savings and enhanced hospice enrollment with a home-based palliative care program implemented as a hospice-private payer partnership,” Journal of Palliative Medicine 2014 Dec;17(12):1328-35.
Not assessed in this study.
Not assessed in this study.
Overall costs for HBPC patients were 36% lower in the final three months of life.
HBPC patients were more likely to enroll in hospice (70% versus 25%) and had longer lengths of stay in hospice (median 34 versus nine days.)
Christopher W Kerr et al., “Clinical impact of a home-based palliative care program: a hospice-private payer partnership,” J Pain Symptom Manage. 2014 Nov;48(5):883-92.e1.
Post-enrollment improvements seen in anxiety, appetite, dyspnea, well-being, depression, and nausea.
Patients, caregivers, and physicians reported high satisfaction (93%-96%) with the program.
HBPC patients had a longer hospice average length of stay of 77.9 days, compared with all other hospice referrals (average length of stay: 56.5 days).
J Brian Cassel, et al., “Effect of a Home-Based Palliative Care Program on Healthcare Use and Costs,” J Am Geriatr Soc. 2016 Nov;64(11):2288-2295
Not assessed in this study.
Not assessed in this study.
Overall costs were 49% - 59% lower depending on the primary disease.
Dana Lustbader et al., “The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization,” Journal of Palliative Medicine 2017 Jan;20(1):23-28.
Not assessed in this study.
Not assessed in this study.
Overall costs for HBPC patients were 37% lower across the final three months of life.
HBPC patients had a higher hospice enrollment rate (57% vs 37%), and a longer median hospice length of service (34 days vs 10 days.)
Keith Kranker et al., “Evaluation of the Medicare Care Choices Model Annual Report 4.” Mathematica report submitted to CMMI April 2022
Net Medicare expenditures were 14% lower for MCCM participants.
MCCM participants had 26% fewer inpatient admissions, 14% fewer outpatient emergency department visits, 38% fewer ICU days, and were 29% more likely to enroll in hospice.
Study Characteristics
Patient Experience
Health & Quality
of Life Outcomes
Utilization and Cost Outcomes
Richard Brumley, et al., “Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care,“ J Am Geriatr Soc. 2007 Jul;55(7):993-1000.
Not assessed in this study.
HBPC patients reported greater improvement in satisfaction with care at 30 and 90 days after enrollment.
Overall costs were 33% lower for HBPC patients.
HBPC patients were more likely to die at home, and were less likely to visit the emergency department or be admitted to the hospital.
Christopher W Kerr et al., “Cost savings and enhanced hospice enrollment with a home-based palliative care program implemented as a hospice-private payer partnership,” Journal of Palliative Medicine 2014 Dec;17(12):1328-35.
Not assessed in this study.
Not assessed in this study.
Overall costs for HBPC patients were 36% lower in the final three months of life.
HBPC patients were more likely to enroll in hospice (70% versus 25%) and had longer lengths of stay in hospice (median 34 versus nine days.)
Christopher W Kerr et al., “Clinical impact of a home-based palliative care program: a hospice-private payer partnership,” J Pain Symptom Manage. 2014 Nov;48(5):883-92.e1.
Post-enrollment improvements seen in anxiety, appetite, dyspnea, well-being, depression, and nausea.
Patients, caregivers, and physicians reported high satisfaction (93%-96%) with the program.
HBPC patients had a longer hospice average length of stay of 77.9 days, compared with all other hospice referrals (average length of stay: 56.5 days).
J Brian Cassel, et al., “Effect of a Home-Based Palliative Care Program on Healthcare Use and Costs,” J Am Geriatr Soc. 2016 Nov;64(11):2288-2295
Not assessed in this study.
Not assessed in this study.
Overall costs were 49% - 59% lower depending on the primary disease.
Dana Lustbader et al., “The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization,” Journal of Palliative Medicine 2017 Jan;20(1):23-28.
Not assessed in this study.
Not assessed in this study.
Overall costs for HBPC patients were 37% lower across the final three months of life.
HBPC patients had a higher hospice enrollment rate (57% vs 37%), and a longer median hospice length of service (34 days vs 10 days.)
Keith Kranker et al., “Evaluation of the Medicare Care Choices Model Annual Report 4.” Mathematica report submitted to CMMI April 2022
Net Medicare expenditures were 14% lower for MCCM participants.
MCCM participants had 26% fewer inpatient admissions, 14% fewer outpatient emergency department visits, 38% fewer ICU days, and were 29% more likely to enroll in hospice.