TOPLINE:

An embedded hospital primary palliative care (HPPC) model led by social workers and nurse practitioners (NPs) was associated with lower ICU use and shorter hospital stays than referral-based specialty palliative care (SPC) in patients with serious illness.

METHODOLOGY:

• Researchers conducted a retrospective cohort analysis of adult patients who received palliative care consultations at an academic medical center in New York City across two time periods: from March 2019 to February 2020 (period 1) and from June 2021 to May 2022 (period 2). Patients who received HPPC (mean age, 69.6 years in period 1 and 71.7 years in period 2) were compared with those who received SPC (mean age, 65.2 and 65.0 years, respectively).
• Both groups had comparable racial and socioeconomic diversity. The HPPC group included approximately 27% Black patients, 23% Latino patients, and 30% Medicaid-insured patients.
• Outcomes included ICU admissions, hospital length of stay, discharge disposition, and 30-day readmissions.
• The HPPC group had higher functional status than the SPC group (median Karnofsky Performance Status score, 40%-40% vs 40%-30%). The predicted in-hospital mortality rate was lower for patients who received HPPC than for those who received SPC (period 1: 14.9% vs 17.9%; P = .03 and period 2: 16.4% vs 23.7%; P < .001). Elixhauser comorbidity indices were similar in both groups.
• The HPPC vs SPC group included a significantly higher number of patients with cancer (period 1: 59.4% vs 41.4%; P < .001 and period 2: 47.9% vs 36.8%; P = .017) and dementia (period 1: 17.9% vs 11.1%; P = .004 and period 2: 21.3% vs 11.0%; P < .001).

TAKEAWAY:

• ICU admission rates were lower in the HPPC group than in the SPC group (period 1: 13.2% vs 41.1% and period 2: 13.6% vs 46.2%; P < .001 for both).
• The median length of hospital stay was shorter for patients who received HPPC than for those who received SPC (period 1: 18.2 vs 21.3 days; P = .03 and period 2: 21.0 vs 24.5 days; P = .01).
• Patients in the HPPC group were more often discharged to home or to a facility than those in the SPC group, whereas hospice enrollment and mortality rates were similar between groups. Readmission rates at 30 days were comparable between groups.
• Patients who received HPPC were more likely to have documented life-prolonging goals of care than those who received SPC (57% vs 32%-35%) and showed consistent outcomes over time.

IN PRACTICE:

“Embedded SW [social worker]/NP-led palliative care represents a sustainable, effective approach to improve access, enhance patient-centered outcomes, and optimize acute care utilization for hospitalized patients with serious illness. These findings support broader adoption of embedded primary palliative care models within hospital medicine,” the authors wrote.

SOURCE:

The study was led by Laura P. Gelfman, MD, MPH, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City. It was published online on February 17, 2026, in the Journal of Palliative Medicine.

LIMITATIONS:

The study was limited by its retrospective design and potential unmeasured confounding. Conducting the research at a single academic medical center limited the generalizability of the findings to other healthcare settings.

DISCLOSURES:

The study received support from the Claude D. Pepper Older Americans Independence Center at the Icahn School of Medicine at Mount Sinai and the Sojourns Scholar Leadership Program from the Cambia Health Foundation. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.