Kerr Christopher W, Donohue Kathleen A, Tangeman John C, Serehali Amin M, Knodel Sarah M, Grant Pei C, Luczkiewicz Debra L, Mylotte Kathleen, Marien Melanie J
1 Center for Hospice and Palliative Care , Cheektowaga, New York.
J Palliat Med. 2014 Dec;17(12):1328-35. doi: 10.1089/jpm.2014.0184.
In the United States, 5% of the population is responsible for nearly half of all health care expenditures, with a large concentration of spending driven by individuals with expensive chronic conditions in their last year of life. Outpatient palliative care under the Medicare Hospice Benefit excludes a large proportion of the chronically ill and there is widespread recognition that innovative strategies must be developed to meet the needs of the seriously ill while reducing costs.
This study aimed to evaluate the impact of a home-based palliative care program, implemented through a hospice-private payer partnership, on health care costs and utilization.
This was a prospective, observational database study where insurance enrollment and claims data were analyzed. The study population consisted of Home Connections (HC) program patients enrolled between January 1, 2010 and December 31, 2012 who subsequently expired (n=149) and who were also Independent Health members. A control group (n=537) was derived using propensity-score matching. The primary outcome variable was overall costs within the last year of life. Costs were also examined at six months, three months, one month, and two weeks. Inpatient, outpatient, ancillary, professional, and pharmacy costs were compared between the two groups. Medical service utilization and hospice enrollment and length of stay were also evaluated.
Cost savings were apparent in the last three months of life—$6,804 per member per month (PMPM) cost for palliative care participants versus $10,712 for usual care. During the last two weeks of life, total allowed PMPM was $6,674 versus $13,846 for usual care. Enhanced hospice entry (70% versus 25%) and longer length of stay in hospice (median 34 versus 9 days) were observed.
Palliative care programs partnered with community hospice providers may achieve cost savings while helping provide care across the continuum.
在美国，5%的人口承担了近一半的医疗保健支出，其中很大一部分支出集中在生命最后一年患有昂贵慢性病的个体身上。医疗保险临终关怀福利项下的门诊姑息治疗将很大一部分慢性病患者排除在外，人们普遍认识到必须制定创新策略，以满足重症患者的需求，同时降低成本。
本研究旨在评估通过临终关怀机构与私人支付方合作实施的居家姑息治疗项目对医疗保健成本和利用率的影响。
这是一项前瞻性观察性数据库研究，分析了保险登记和理赔数据。研究人群包括2010年1月1日至2012年12月31日期间登记参加“家庭联系”（HC）项目、随后去世且也是独立健康保险公司成员的患者（n = 149）。使用倾向得分匹配法得出一个对照组（n = 537）。主要结局变量是生命最后一年的总体成本。还在六个月、三个月、一个月和两周时对成本进行了检查。比较了两组的住院、门诊、辅助、专业和药房成本。还评估了医疗服务利用率、临终关怀登记情况和住院时间。
在生命的最后三个月，成本节约明显——姑息治疗参与者的人均每月成本（PMPM）为6804美元，而常规治疗为10712美元。在生命的最后两周，允许的PMPM总额为6674美元，而常规治疗为13846美元。观察到临终关怀机构的入院率提高（70%对25%），临终关怀机构的住院时间延长（中位数34天对9天）。
与社区临终关怀机构合作的姑息治疗项目可能在实现成本节约的同时，有助于提供全程护理。
