Key result
Palliative care utilization among lung cancer admissions with a high risk of mortality was associated with a 1.22-day shorter hospital length of stay and $13,208 lower hospital charges.
Why the study?
End-of-life inpatient care drives substantial healthcare expenditure in diseases such as lung cancer, but the association of palliative care with hospital utilization and national palliative care trends remained uncharacterized.
Does palliative care utilization reduce hospital length of stay and charges in adults admitted with lung cancer and high risk of mortality?
Cross-Sectional (n=11,185,408)
Yes
Does palliative care utilization reduce hospital length of stay and charges in adults admitted with lung cancer and high risk of mortality?
Mean Difference: -1.22
p-value: p=<0.001
Palliative care utilization in high-mortality lung cancer admissions is associated with significantly reduced hospital length of stay and charges, though its growth has decelerated since 2016.
PC was associated with reduced utilization in high-risk LC; leaves open whether integration improves outcomes in prospective trials.
Background The top 5% of healthcare utilization accounts for 60% of healthcare expenditure in the U.S., with the majority of the costs occurring in the last year of life for hospital inpatient services for diseases such as lung cancer (LC). Previous years' concentrated healthcare expenditure burdens have been shared globally. The research questions of this study are whether palliative care (PC) is associated with hospital utilization and what the PC trends are in U.S. hospitals. Thus, this study aimed to examine (1) the impact of hospital PC on hospital utilization charges and length of stay (LOS), and (2) PC trends, particularly before and after 2016 when a tri-convergent shift occurred in federal reimbursement, professional clinical guideline establishment, and legislative policy. Methods This was a retrospective study that analyzed the National Inpatient Sample between 2002 and 2021. Adults 18+ years with LC and high-risk mortality were identified as the denominator. PC utilization was the main outcome measurement and the numerator. Hospital LOS (in days) and charges were secondary outcome measurements. An interrupted time series analysis was applied in 2016 as a U.S. healthcare breakpoint. Results A total of 11,185,408 admissions were identified. PC utilization increased from 2.38% in 2002–2006 to 7.74% in 2007–2011, 13.29% in 2012–2016, and 15.86% in 2017–2021 ( p < 0.001). The upward trend in PC utilization has decelerated by 6.40% ( t = −9.67, p < 0.001) since 2016. PC was associated with a 1.22-day shorter LOS ( t = −48.2, p < 0.001) and hospital charges that were $13,208.85 lower ( t = −39.95, p < 0.001). Conclusion PC utilization increased but slowed from 2016, with underuse persisting (<20% in 2021) among LC admissions in U.S. hospitals. PC utilization improves efficiency among patients with LC and a high risk of mortality by reducing hospital LOS and charges by 15%, respectively.
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Hwang et al. (2026) conducted a cross-sectional in Lung cancer with high risk of mortality (n=11,185,408). Palliative care vs. No palliative care was evaluated on Hospital length of stay (MD -1.22 days, p=<0.001). Palliative care utilization among lung cancer admissions with a high risk of mortality was associated with a 1.22-day shorter hospital length of stay and $13,208 lower hospital charges.
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