Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs

Abstract

ObjectivesTo evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries.DesignObservational, retrospective study using propensity‐based matching.SettingA health system in southern California.ParticipantsIndividuals who received the intervention between 2007 and 2014 (n = 368) were matched with 1,075 comparison individuals within each of four disease groups: cancer, chronic obstructive pulmonary disease, heart failure, and dementia. All were known to be dead at the time of the retrospective study, were Medicare Advantage beneficiaries, and had 2 years of usage data before death. Median age at death for each disease group was older than 80.InterventionHome‐ and clinic‐based palliative care (PC) services provided by a multidisciplinary team.MeasurementsOutcomes included hospital costs, other healthcare costs, readmission rates, hospital admissions and bed days, intensive care unit use in final 30 days of life, and death within 30 days of an admission.ResultsIntervention participants in all four disease groups had less hospital use and lower hospital costs nonintervention participants, which drove lower overall healthcare costs. In the final 6 months of life, healthcare costs for the intervention groups stayed largely the same from month to month, whereas costs for comparison participants increased dramatically.ConclusionIn the context of an alternative payment model in which the provider was “at risk” of bearing the costs of care, a proactive PC program helped to avoid the escalation in hospital use and costs commonly seen in the final months of life.

Hospital readmission in persons with dementia: A systematic review

“…One checklist is for evaluating observational cohort and cross-sectional studies, 14 32 Sixteen studies were observational, that is, one longitudinal, 20 four prospective, 9,21,24,28 and 11 retrospective. 17,27 Studies were conducted at different levels in terms of sample scales, including three national-level, 22,24,25 four state or regional, 8,18,30,31 four multisite, 16,17,19,26 and eight single-site studies. 17,27 Studies were conducted at different levels in terms of sample scales, including three national-level, 22,24,25 four state or regional, 8,18,30,31 four multisite, 16,17,19,26 and eight single-site studies.…”

“…8,16,18,19,22,23,25,[29][30][31][32] Three were intervention studies, that is, one randomized controlled trial (RCT) 26 and two quasiexperimental studies. 9,20,21,23,[27][28][29]32 Various data sources were used, including patient medical records (n = 12, 67%), 9,16,17,[19][20][21]23,[26][27][28][29]31,32 billing and/or claims files (n = 6, 33%), 8,16,18,20,22,25 registry data (n = 5, 28%), 9,16,24,30,31 and surveys and/or interviews (n = 9, 50%). 9,20,21,23,[27][28]…”

“…17,27 Studies were conducted at different levels in terms of sample scales, including three national-level, 22,24,25 four state or regional, 8,18,30,31 four multisite, 16,17,19,26 and eight single-site studies. 9,16,17,[19][20][21]26,27,29 The majority of studies used multiple data sources to approach their research aims. 9,16,17,[19][20][21]26,27,29 The majority of studies used multiple data sources to approach their research aims.…”

“…16,19,22,32 Seven studies from different regions used medical records and/or ICD-9/10 codes or country-specific version of ICD codes. Four research teams did not explicitly explain the criteria used for identifying study participants.…”

“…Several studies did not report criteria for identifying persons with dementia; 16,19,21,32 a couple of studies that used a small sample size did not conduct power analysis; 9,21 and some studies only conducted bivariate analysis without controlling for potential confounders. Some studies demonstrated moderate to good quality by meeting the majority of criteria on the quality checklists, but some studies were limited by methodological flaws.…”