Managed Care, Hospice Use, Site of Death, and Medical Expenditures in the Last Year of Life

Emanuel, Ezekiel J.; Ash, Arlene S.; Yu, Wei; Gazelle, G. Scott; Levinsky, Norman G.; Saynina, Olga; McClellan, Mark; Moskowitz, Mark A.

doi:10.1001/archinte.162.15.1722

Cited by 151 publications

(132 citation statements)

References 15 publications

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“…[15][16][17][18][19][20] The adequate utilization of hospice services requires timely referral of terminally ill patients to hospice programs. 21,22 Hospice care remains underutilized and patients are often referred to hospice very late in the course of their disease.…”

Section: Discussionmentioning

confidence: 99%

Impact of Combined Hospice Care on Terminal Cancer Patients

Loke

Rau

Huang

2011

Journal of Palliative Medicine

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Background: Many patients with advanced cancer will develop physical and psychological symptoms related to their disease. These symptoms are infrequently treated by conventional care. Palliative care programs have been developed to fill this gap in care. However, there are limited beds in hospice units. To allow more terminal cancer patients to receive care from a hospice team, a combined hospice care system was recently developed in Taiwan. This study is a report of our experiences with this system. Patients and Methods: From January to December 2009, terminal cancer patients who accepted consultation from a hospice team for combined hospice care were enrolled in the study. Demographic data, clinical symptoms, referring department, type of cancer, and outcome were analyzed. Results: A total of 354 terminal cancer patients in acute wards were referred to a hospice consulting team. The mean patient age was 61 years, and the proportion of males was 63.28%. After combined hospice care, there was a significant improvement in the sign rate of do-not-resuscitate (DNR) orders from 41.53% to 71.47% ( p < 0.0001), and awareness of disease prognosis from 46.05% to 57.69% ( p ¼ 0.0006). Combined hospice care also enabled 64.21% of terminal cancer patients who were not transferred to hospice ward to receive combined care by a hospice consulting team while in acute wards, thus increasing the hospice utilization of terminal cancer patients. The major symptoms presented by the patients were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%). Conclusions: Through the hospice consulting system, hospice combined care has a positive effect on the utilization of hospice care, rate of DNR signing and quality of end-of-life care for terminal cancer patients.

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Section: Discussionmentioning

confidence: 99%

Impact of Combined Hospice Care on Terminal Cancer Patients

Loke

Rau

Huang

2011

Journal of Palliative Medicine

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“…This is doubtless an issue of great interest, since it can have a direct impact on the planning and development of health care strategies. The health system has been continuously challenged to improve its efficacy by improving the quality of medical services and reducing costs (1,11). An understanding of the factors related to the use of resources and to the increased costs in the last years of life can lead to more rational use of scarce resources (12)(13)(14)(15).…”

mentioning

confidence: 99%

Health care costs in the last four years of life for private health plan beneficiaries in Brazil

Ferraz¹,

Miranda²,

Padovan³

et al. 2008

Rev Panam Salud Publica

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Objective. To examine health care use and expenditures by Brazilians covered by private health care plans in the last four years of life. Methods. Health plan provider enrollee files and death certificate data were used for 274 health plan beneficiaries who died in 1998, 1999, and 2000Death; health care costs; insurance, health; terminal care; Brazil. ABSTRACTIn most populations, life expectancy has increased progressively, generating the need for extended health care for those who now live longer. The significant rise in the incidence of comorbidities and progress in the diagnosis and treatment technologies that are available to extend and improve life have had an impact on the ageing population. Extended life expectancy has been pointed to as the main determinant of increased health care costs in industrialized nations (1, 2). Some authors suggest that rather than the age of a patient, the last months of life and the technological interventions now available are the most important factors determining increased health costs (3, 4).The consequent increase in health care costs is challenging and has motivated intensive research for better strategies for the health care system. The specialized literature suggests that terminal patients receive most of their

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“…60 Almost two-thirds of terminally ill people for whom home or hospice palliative care would be appropriate die in hospital, 61 often receiving heroic interventions. In one study, 25% of beds in 69 intensive care units (ICUs) were occupied by patients whom attending intensivists perceived as receiving inappropriate care.…”

Section: Adopt a More Conservative Approach Nearing The End Of Lifementioning

confidence: 99%

Ten clinician-driven strategies for maximising value of Australian health care

Scott¹

2014

Aust. Health Review

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Objective. To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable.Methods. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy.Results. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low-or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings.Conclusions. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia.What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low-to highvalue care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.

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Managed Care, Hospice Use, Site of Death, and Medical Expenditures in the Last Year of Life

Cited by 151 publications

References 15 publications

Impact of Combined Hospice Care on Terminal Cancer Patients

Impact of Combined Hospice Care on Terminal Cancer Patients

Health care costs in the last four years of life for private health plan beneficiaries in Brazil

Ten clinician-driven strategies for maximising value of Australian health care

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