Palliative Care in Patients With COVID-19: Analysis of Costs of Hospitalization in Wards and Intensive Care Units
- Conditions
- Palliative CareCOVID-19
- Interventions
- Other: Analysis of costs with patient care during hospitalization
- Registration Number
- NCT05897229
- Lead Sponsor
- University of Sao Paulo General Hospital
- Brief Summary
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
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.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 200
- 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.
- absence of hospitalization cost data in the institution's electronic records
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description ICU - end-stage disease criteria and high risk of death from the disease prior to COVID-19 Analysis of costs with patient care during hospitalization 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. PC - end-stage disease criteria and high risk of death from the disease prior to COVID-19 Analysis of costs with patient care during hospitalization 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. PC & ICU - end-stage disease criteria and high risk of death from the disease prior to COVID-19 Analysis of costs with patient care during hospitalization 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.
- Primary Outcome Measures
Name Time Method Direct costs (supplies) Hospitalizations between April 8th to July 31th, 2020 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.
Cost minimization, and consequential cost analysis Hospitalizations between April 8th to July 31th, 2020 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.
Direct costs (working hours) Hospitalizations between April 8th to July 31th, 2020 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.
- Secondary Outcome Measures
Name Time Method Clinical profile Hospitalizations between April 8th to July 31th, 2020 diagnosis, underlying disease, comorbidities to identify and analyze the profile of the patients included in the study.
Outcome of hospitalization Hospitalizations between April 8th to July 31th, 2020 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.
Sociodemographic profile Hospitalizations between April 8th to July 31th, 2020 age and sex to identify and analyze the profile of the patients included in the study.
Time to call Palliative Care group Hospitalizations between April 8th to July 31th, 2020 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.
Life-sustaining procedures Hospitalizations between April 8th to July 31th, 2020 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.
Inpatient daily rates Hospitalizations between April 8th to July 31th, 2020 rates for Palliative Care unit (PC), ICU and PC \& ICU to analyze the costs.
Length of stay and inpatient settings Hospitalizations between April 8th to July 31th, 2020 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.