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

Abstract

OBJECTIVE Healthcare organizations are expanding community‐based serious illness care programs to deliver care for homebound patients. Programs typically focus on home‐based primary care or home‐based palliative care, yet this population may require both services. We developed and evaluated a primary and palliative care program serving seriously ill older adults, called the Reaching Out to Enhance the Health of Adults in Their Communities and Homes (REACH) program. Our objective was to determine the impact of the REACH program on healthcare utilization and the patient care experience. DESIGN Case study using medical record review and telephone interviews. SETTING Home‐based serious illness care program in central North Carolina. PARTICIPANTS Patients enrolled in the REACH program from August 2014 to March 2016 (n = 159). INTERVENTION Home‐based primary and palliative care delivered by an interdisciplinary team for seriously ill older adults. MEASUREMENTS Structured medical record review including demographics, health and functional status, and acute hospitalization and emergency department (ED) visits in the 12 months preceding and following initiation of the REACH program. A convenience sample of participants completed telephone interviews that measured the quality‐of‐care experience and quality of communication. RESULTS REACH patients had a 43% reduction in hospital visits and a 25% reduction in ED visits. Participants in telephone interviews reported a high‐quality care experience and very good quality of communication with REACH providers. CONCLUSION A care model that integrates home‐based primary care and palliative care has the potential to reduce health service utilization and enhance the care experience for older patients with serious illness. J Am Geriatr Soc 67:825–830, 2019.

Evaluating the care provision of a community-based serious-illness care program via chart measures

“…We recorded independence in IADLs and ADLs (Yes/No). Other measures such as hospitalization and palliative care measures are reported elsewhere [16,18].…”

“…To better understand the current quality-of-care, we created operational definitions for selected quality-of-care measures and used them to evaluate a community-based serious-illness care program. The program has been evaluated for its impact in older adults with dementia, its impact on healthcare utilization, and in palliative care, but not in proposed quality-of-care [ 16 , 17 ]. The aim of the study was to determine if we could operationalize proposed quality-of-care domains and then evaluate our program [ 8 , 9 ].…”

Evaluating the Care Provision of a Community-Based Serious-Illness Care Program Via Chart Measures

“…The REACH program was a community-based serious-illness care program that extends both medical and palliative care to seriously ill and medically complex adults in their homes or assisted living communities. (16)(17)(18) The REACH program was designed to meet the needs of patients and primary care providers and thus offered an array of services from short-term consultation to ongoing co-management to assuming primary care if needed. The REACH program was interdisciplinary, with a team comprised of: (1) clinicians (MD, DO, nurse practitioner) with expertise in geriatrics and/or palliative care; (2) a clinical pharmacist (PharmD); (3) a care manager (Master's of Social Work); and (4) a nurse coordinator (RN) who trained in the Guided Care model, a model designed to coordinate care across healthcare settings.…”

“…The program has been evaluated for its impact in older adults with dementia, its impact on healthcare utilization, and in palliative care, but not in proposed quality-of-care. (16,17) The aim of the study was to determine if we could operationalize proposed quality-of-care domains and then evaluate our program. (8,9)…”

Evaluating the Care Provision of a Community-Based Serious-Illness Care Program Via Chart Measures

“…The program has been evaluated for its impact in older adults with dementia, its impact on healthcare utilization, and in palliative care, but not in proposed quality-of-care. (16,17) The aim of the study was to determine if we could operationalize proposed quality-of-care domains and then evaluate our program. (7,8) Methods…”