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

OBJECTIVES: To evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries. DESIGN: Observational, retrospective study using propensity‐based matching. SETTING: A health system in southern California. PARTI...

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Autores principales: Brian Cassel, J., Kerr, Kathleen M., McClish, Donna K., Skoro, Nevena, Johnson, Suzanne, Wanke, Carol, Hoefer, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5118096/
https://www.ncbi.nlm.nih.gov/pubmed/27590922
http://dx.doi.org/10.1111/jgs.14354
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author Brian Cassel, J.
Kerr, Kathleen M.
McClish, Donna K.
Skoro, Nevena
Johnson, Suzanne
Wanke, Carol
Hoefer, Daniel
author_facet Brian Cassel, J.
Kerr, Kathleen M.
McClish, Donna K.
Skoro, Nevena
Johnson, Suzanne
Wanke, Carol
Hoefer, Daniel
author_sort Brian Cassel, J.
collection PubMed
description OBJECTIVES: To evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries. DESIGN: Observational, retrospective study using propensity‐based matching. SETTING: A health system in southern California. PARTICIPANTS: Individuals 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. INTERVENTION: Home‐ and clinic‐based palliative care (PC) services provided by a multidisciplinary team. MEASUREMENTS: Outcomes 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. RESULTS: Intervention 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. CONCLUSION: In 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.
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spelling pubmed-51180962016-12-02 Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs Brian Cassel, J. Kerr, Kathleen M. McClish, Donna K. Skoro, Nevena Johnson, Suzanne Wanke, Carol Hoefer, Daniel J Am Geriatr Soc Clinical Investigations OBJECTIVES: To evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries. DESIGN: Observational, retrospective study using propensity‐based matching. SETTING: A health system in southern California. PARTICIPANTS: Individuals 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. INTERVENTION: Home‐ and clinic‐based palliative care (PC) services provided by a multidisciplinary team. MEASUREMENTS: Outcomes 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. RESULTS: Intervention 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. CONCLUSION: In 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. John Wiley and Sons Inc. 2016-09-02 2016-11 /pmc/articles/PMC5118096/ /pubmed/27590922 http://dx.doi.org/10.1111/jgs.14354 Text en © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Clinical Investigations
Brian Cassel, J.
Kerr, Kathleen M.
McClish, Donna K.
Skoro, Nevena
Johnson, Suzanne
Wanke, Carol
Hoefer, Daniel
Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs
title Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs
title_full Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs
title_fullStr Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs
title_full_unstemmed Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs
title_short Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs
title_sort effect of a home‐based palliative care program on healthcare use and costs
topic Clinical Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5118096/
https://www.ncbi.nlm.nih.gov/pubmed/27590922
http://dx.doi.org/10.1111/jgs.14354
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