Improvements in healthcare utilization due to expansion of an embedded palliative care clinic for patients with thoracic malignancies.

318 Background: Early palliative care (PC) is recommended for patients with advanced lung cancer. In embedded clinics, palliative care clinicians see patients alongside disease specialists in the same clinical space with the goal of increasing patient access to palliative care services without additional transportation and time burden. In our prior work, we observed a significant decrease in emergency department (ED) visits after embedding a PC physician 2 days per week within a thoracic medical oncology clinic. The primary aim of this study was to investigate healthcare utilization among patients with a thoracic malignancy after expanding embedded PC to 5 days per week. Methods: This is a retrospective cross-sectional cohort study comparing healthcare utilization among three cohorts: (1) “pre-cohort” 12 months prior to implementing embedded PC, (2) “post-cohort” 12 months after opening the embedded clinic with capacity for 20 PC patients/week, and (3) “expansion cohort” 15 months after expanding the embedded clinic capacity to 51 PC patients/week. Patients were included if they had a new diagnosis of lung cancer, ≥2 outpatient visits with thoracic medical oncology, and resided within the same or adjacent county to this single site comprehensive cancer center. In the pre-cohort, access to PC was available at a stand-alone clinic located 2 miles from the thoracic medical oncology clinic. PC in all cohorts encompassed symptom assessment and management, advance care planning, and goals of care discussion as appropriate. We evaluated the outcomes of ED visits, hospital admissions, and intensive care unit (ICU) admissions in rates per-person-years (PPY) with Poisson regression models. Results: In total, 794 patients met criteria for analysis (214 pre-cohort, 260 post-cohort, and 320 expansion cohort patients). Among all patients, 46% were female, and the median age was 67 years (IQR: 61, 74). PC exposure included 7.9% (17/214) of the pre-cohort, 13.8% (36/260) of the post-cohort, and 36.6% (117/320) of the expansion cohort. In the expansion cohort, 320 patients contributed 246.7 years of observation time during which we observed 503 ED visits (2.04 PPY), 435 hospitalizations (1.76 PPY), and 103 ICU admissions (0.42 PPY). The expansion cohort had 40.5% and 19.7% reductions in ED visits compared to the pre- and post-cohorts, respectively. Similarly, the expansion cohort had 59.9% and 53.3% reductions in hospitalizations compared to the pre- and post-cohorts, respectively. There was no significant difference in ICU admissions. Conclusions: Expansion of embedded palliative care services in a thoracic medical oncology clinic is supported by reductions in unplanned healthcare utilization for patients with thoracic malignancies.