An Evaluation of the Advanced Illness Management (AIM) Program: Increasing Hospice Utilization in the San Francisco Bay Area

Abstract

The AIM program was successful at increasing hospice utilization through a targeted intervention focused on palliative and end-of-life care, increased patient education and decision making, and a dynamic treatment approach. The finding of increased utilization by African Americans, a population traditionally reluctant to use hospice, was particularly noteworthy.

The Growth of Palliative Care in the United States

“…Like Kaiser Permanente, Sutter Health is a vertically integrated HMO that provides medical services to an insured population. The Sutter Health Program of Advanced Illness Management (AIM) started with a needs analysis that showed lack of home care and home assistance, leading to emergency room (ER) visits and admissions, with lack of system-wide communication (23). Sutter Health redesigned their medical care services to include more home care and visits, with an emphasis on choices (advance directives) in seriously ill patients (63).…”

Interventions to Improve Hospice and Palliative Care Referral: A Systematic Review

“…[21][22][23][24][25][26] The median follow up time was 1.5 years and range from 1 to 2 years. We identified one randomized control trial, 21 two pre-post studies, 23,26 and three retrospective cohort studies.…”

“…We identified one randomized control trial, 21 two pre-post studies, 23,26 and three retrospective cohort studies. 22,24,25 Three of the six studies reported on intervention among nursing home patients. 21,23,25 The other three reported on home care patients, 24 heart failure patients, 22 and Medicaid care managers.…”

“…22,24,25 Three of the six studies reported on intervention among nursing home patients. 21,23,25 The other three reported on home care patients, 24 heart failure patients, 22 and Medicaid care managers. 26 All studies evaluated a total of 3559 patients.…”

Hospice Psychosocial Service Availability and Utilization in the United States

“…There have not been a significant amount of generalizable studies on the utilization of the palliative care model by minorities. The few published studies indicate that minority hospice enrollment rates are higher when patients receive palliative care first which lends to greater satisfaction with the hospice care model, increased documentation of treatment goals, along with an increased likelihood of death at home (Bell, Kuriya, & Fischberg, 2011;Ciemins et al, 2006;Holley et al, 2009;Zaide et al, 2012). Social work researchers can examine this aspect further with more generalizable studies to determine if increased minority community education and access to palliative care programs as an early intervention model can assuage the disparities seen in the enrollment and continued utilization of hospice services.…”