# Association between hospital palliative care team intervention volume and patient outcomes

## TL;DR

Higher hospital palliative care team activity is linked to better patient outcomes like lower delirium, mortality, and disability in cancer patients.

## Contribution

This study shows that higher volume of palliative care team interventions is associated with improved clinical outcomes in cancer patients.

## Key findings

- High-volume palliative care teams reduced 30-day delirium odds by 20-21%.
- High-volume teams cut 30-day mortality odds by 41% compared to low-volume teams.
- High-volume interventions were linked to 48% lower odds of ADL decline at discharge.

## Abstract

The benefits of palliative care in patients with advanced cancer are well established. However, the effect of the skills of the palliative care team (PCT) on patient outcomes remains unclear. Our aim was to evaluate the association between hospital PCT intervention volume and patient outcomes in patients with cancer.

A retrospective cohort study was conducted using a nationwide inpatient database in Japan. Patients with cancer receiving chemotherapy and PCT intervention from 2015 to 2020 were included. The outcomes were incidence of hyperactive delirium within 30 days of admission, mortality within 30 days of admission, and decline in activities of daily living (ADL) at discharge. The exposure of interest was hospital PCT intervention volume (annual number of new PCT interventions in a hospital), which was categorized into low-, intermediate-, and high-volume groups according to tertiles. Multivariate logistic regression and restricted cubic-spline regression were conducted.

Of 29,076 patients, 1495 (5.1%), 562 (1.9%), and 3026 (10.4%) developed delirium, mortality, and decline in ADL, respectively. Compared with the low hospital PCT intervention volume group (1–103 cases/year, n = 9712), the intermediate (104–195, n = 9664) and high (196–679, n = 9700) volume groups showed significant association with lower odds ratios of 30-day delirium (odds ratio, 0.79 [95% confidence interval, 0.69–0.91] and 0.80 [0.69–0.93], respectively), 30-day mortality (0.73 [0.60–0.90] and 0.59 [0.46–0.75], respectively), and decline in ADL (0.77 [0.70–0.84] and 0.52 [0.47–0.58], respectively).

Hospital PCT intervention volume is inversely associated with the odds ratios of delirium, mortality, and decline in ADL among hospitalized patients with cancer.

The online version contains supplementary material available at 10.1007/s10147-024-02574-4.