Community-Based Models of Care Delivery for People with Serious Illness

Abstract

The 20th century saw remarkable improvements in life expectancy (NIA, 2011). Improvements in access to clean water, disease screening and prevention, the discovery of antibiotics and vaccines, development of organ transplantation, and advances in treatment for heart disease and cancer have all contributed to an expectation that Americans will live long lives in generally good health.

“Yes! We Have a Home‐Based Palliative Care Program!”

“…The guidelines, while not specific to HBPalC alone, delineate eight domains that programs can use to inform program design and quality improvement efforts (structure and processes; physical; psychological and psychiatric; spiritual, religious, and existential; cultural aspects of care; and care near the end of life). Complimentary to the National Consensus Project (NCP) guidelines, Cohn and colleagues propose foundational elements and core competencies that community‐based palliative care programs must possess to ensure high‐quality care . Quality standards emanating from systematic input from patient advocates, professional societies (including the American Academy of Hospice and Palliative Medicine and the American Academy of Homecare Medicine), and home‐based medical practices were also recently published in 2018 and highlighted specific standards particularly relevant to the home setting …”

The Impact of a Community‐Based Serious Illness Care Program on Healthcare Utilization and Patient Care Experience

“…[2][3][4][5] These patient populations have complex care needs, such as difficulty in accessing care, 6 and healthcare systems and stakeholders are looking to evolving community-based care models that have the capacity for (1) integrating the fragmentation of primary, specialty, and hospice care services across care delivery sites; (2) engaging and coordinating social and community-based services with medical care; and (3) providing support for family and other caregivers. 7 The rapid growth in the number of community-based serious illness care (CBSC) programs for homebound patients in recent years has led to a wide range of clinical models: advanced care programs, community-based palliative care, geriatric care teams, and home-based primary care (HBPC). 7 An early innovative model, HBPC was developed by the Veterans Administration (VA) health system in the 1990s 8,9 and continues to be a cost-effective program that reduces unnecessary hospital and emergency department (ED) utilization.…”

“…7 The rapid growth in the number of community-based serious illness care (CBSC) programs for homebound patients in recent years has led to a wide range of clinical models: advanced care programs, community-based palliative care, geriatric care teams, and home-based primary care (HBPC). 7 An early innovative model, HBPC was developed by the Veterans Administration (VA) health system in the 1990s 8,9 and continues to be a cost-effective program that reduces unnecessary hospital and emergency department (ED) utilization. 10 More recently, non-VA-based programs have grown significantly, such as those that participated in Medicare's Independence at Home demonstration project, initiatives that have saved approximately $3000 per beneficiary, primarily by reducing hospital use.…”

Accountability for the Quality of Care Provided to People with Serious Illness

“…These programs are heterogeneous, with diverse definitions of serious illness [2][3][4] and serious illness care 2,3,5 and…”

“…Accepted November 3, 2017. an array of care models, program staffing, settings, and organizational sponsors. 2,5 But a dearth of performance measures and accountability programs addressing the quality of such care means that consumers lack the means to identify health plans, serious illness care programs, or providers delivering high-quality person-and familycentered care. 2 With support from the Gordon and Betty Moore Foundation, the National Committee for Quality Assurance (NCQA) is developing serious illness care performance measures and evaluating the potential for serious illness care accountability programs.…”