Palliative Care in Patients With COVID-19: Analysis of Costs of Hospitalization in Wards and Intensive Care Units

Study Overview
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Brief Summary
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The confrontation of COVID-19 foreshadowed a serious crisis of scarce health resources worldwide. To assist in this confrontation, the Palliative Care Scientific Technical Core of the Clinical Hospital, School of Medicine, Sao Paulo University (USP) elaborated a Triage Protocol for Palliative Care (PALI-COVID Tool) and it was possible to categorize the patients in three groups, according to the risk of death and needs of Palliative Care (PC), through the clinical evaluation of the patient that also directed them to the hospitalization resource according to their need (ward x ICU).

Detailed Description
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The patients grouped as with higher risk of death and PC needs (green group) by PALI-COVID Tool were those with a profile of end-of-life, signs of clinical deterioration and risk of death on admission and thus indicated for admission to the COVID-19 Palliative Care Inpatient Unit, however some were admitted to the ICU. Objective: to analyze the direct costs of hospitalization of COVID-19 Palliative Care patients in Palliative Care Inpatient Unit and ICU screened as green group by the COVID-19 Screening Protocol developed in the institution. Methods: observational, cross-sectional and retrospective study of the service database of patients over 18 years of age screened as the green group (PALI-COVID). The variables to be investigated are related to sociodemographic and clinical data, length of stay and hospitalization scenarios, time to call for PC, outcome and costs.

Official Title
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Palliative Care in Patients With COVID-19: Analysis of Costs of Hospitalization in Wards and Intensive Care Units

Conditions
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COVID-19, Palliative Care

Intervention / Treatment
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* Other: Analysis of costs with patient care during hospitalization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: inpatients with severe forms of COVID-19 between April 08 and July 31, 2020 positive reverse-transcriptase polymerase chain reaction (RT-PCR). patients with terminal illness and high clinical risk of death before COVID-19. those admitted to an ICU or palliative care unit. Exclusion Criteria: absence of hospitalization cost data in the institution's electronic records

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| PC - end-stage disease criteria and high risk of death from the disease prior to COVID-19<br>Patients with severe forms of COVID-19 (RT-PCR+) admitted to a high-complexity hospital. Of these, patients with end-stage disease criteria and high risk of death from the disease prior to COVID-19 were admitted, at clinical criteria, to palliative care unit. If there are patients who received both types of treatment, this group will also be analyzed. | Other: Analysis of costs with patient care during hospitalization<br>* Analysis of direct costs with supplies, medications, diets, laboratory tests and imaging exams, and invasive procedures such as mechanical ventilation, dialysis, and the use of vasoactive drugs.-analysis of costs referring to working hours of physicians, nurses and physical therapists in each unit normalized for the same number of beds.- cost minimization and consequential cost analysis.<br>|
| ICU - end-stage disease criteria and high risk of death from the disease prior to COVID-19<br>Patients with severe forms of COVID-19 (RT-PCR+) admitted to a high-complexity hospital. Of these, patients with end-stage disease criteria and high risk of death from the disease prior to COVID-19 were admitted, at clinical criteria, to the ICU. If there are patients who received both types of treatment, this group will also be analyzed. | Other: Analysis of costs with patient care during hospitalization<br>* Analysis of direct costs with supplies, medications, diets, laboratory tests and imaging exams, and invasive procedures such as mechanical ventilation, dialysis, and the use of vasoactive drugs.-analysis of costs referring to working hours of physicians, nurses and physical therapists in each unit normalized for the same number of beds.- cost minimization and consequential cost analysis.<br>|
| PC & ICU - end-stage disease criteria and high risk of death from the disease prior to COVID-19<br>Patients with severe forms of COVID-19 (RT-PCR+) admitted to a high-complexity hospital. Of these, patients with end-stage disease criteria and high risk of death from the disease prior to COVID-19 were admitted, at clinical criteria, to the ICU and palliative care unit. If there are patients who received both types of treatment, this group will also be analyzed. | Other: Analysis of costs with patient care during hospitalization<br>* Analysis of direct costs with supplies, medications, diets, laboratory tests and imaging exams, and invasive procedures such as mechanical ventilation, dialysis, and the use of vasoactive drugs.-analysis of costs referring to working hours of physicians, nurses and physical therapists in each unit normalized for the same number of beds.- cost minimization and consequential cost analysis.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Direct costs (supplies) | costs related to supplies, medications, diets, laboratory tests, imaging exams, and invasive procedures (such as mechanical ventilation, dialysis, and the use of vasoactive drugs). The costs will be calculate for the three groups and compared between them. | Hospitalizations between April 8th to July 31th, 2020 | 
| Direct costs (working hours) | costs referring to working hours of health professionals (physicians, nurses and physical therapists) in each unit normalized for the same number of beds. The costs will be calculate for the three groups and compared between them. | Hospitalizations between April 8th to July 31th, 2020 | 
| Cost minimization, and consequential cost analysis | all the costs will be compared between them to do a cost-effectiveness analysis as the death rate will be probabily similar in the three groups. | Hospitalizations between April 8th to July 31th, 2020 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sociodemographic profile | age and sex to identify and analyze the profile of the patients included in the study. | Hospitalizations between April 8th to July 31th, 2020 | 
| Clinical profile | diagnosis, underlying disease, comorbidities to identify and analyze the profile of the patients included in the study. | Hospitalizations between April 8th to July 31th, 2020 | 
| Length of stay and inpatient settings | length of stay at Palliative Care unit (PC), ICU and PC & ICU to identify and analyze the profile of the patients included in the study and analyze the costs. | Hospitalizations between April 8th to July 31th, 2020 | 
| Time to call Palliative Care group | admission to the institution, date of call of PC, first assessment of PC, indication of transfer to a COVID-19 PC unit, and date of transfer to PC unit to identify and analyze the time it took for staff to recognize the need for CP for the patients that has repercussions on the cost of hospitalization. | Hospitalizations between April 8th to July 31th, 2020 | 
| Life-sustaining procedures | such as mechanical ventilation, dialysis, and the use of vasoactive drugs to identify and analyze the use of life-sustaining procedures in the study population and analyze the costs. | Hospitalizations between April 8th to July 31th, 2020 | 
| Inpatient daily rates | rates for Palliative Care unit (PC), ICU and PC & ICU to analyze the costs. | Hospitalizations between April 8th to July 31th, 2020 | 
| Outcome of hospitalization | hospital discharge, transference, and death to identify and analyze the profile of the patients included in the study and to make a cost-effectiveness analysis with the all costs that will be analyzed. | Hospitalizations between April 8th to July 31th, 2020 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Palliative care, COVID-19, Cost allocation, Cost control, Organization and Administration