Wolsfeld, L, Hendricks, A, Gardner, J, & Shreve, S.T. (2010). “Setting a Standard for a Hospice or Palliative Care Referral for Acute Cancer Inpatients.” Health Care Financing and Economics. Retrieved from http://www.hcfe.research.va.gov/HCFERESEARCH/docs/wp_2010_01.pdf.
The objective of this research was to develop a case finding method that can be used as the basis for an hospice or palliative care referral for inpatient cancer patients. This was a retrospective study using secondary data from administrative sources. The analysis used five years – FY2001 through FY2005 – of inpatient data from the VA National Patient Care Database (NPCD) to identify patients. VA Vital Status Files were used to ascertain each patient’s date of death through March, 2006. A survival model from the index date to time of death (which was right-censored by the last date for which dates of death were known) included age, gender and the presence of metastatic disease as covariables and was estimated using the LIFEREG procedure from SAS. The 50th percentile (the median) of the predicted number of months of survival was calculated for each of the specified cancers. Categories for which median survival time was less than or equal to 12 months were preliminarily included in the case finding metric. Only about a third of patients in these categories received HPC within the VA system during a subset of study years analyzed. In summary, the intention of a case finding metric is to alert the physician to the possibility that it may be an appropriate time to discuss HPC with the patient and family members.
