1 Research, Development & Dissemination, Sutter Health, Walnut Creek, CA, USA.
2 California Pacific Medical Center, San Francisco, CA, USA.
Palliat Med. 2018 Feb;32(2):485-492. doi: 10.1177/0269216317711824. Epub 2017 Jun 7.
Home-based care coordination and support programs for people with advanced illness work alongside usual care to promote personal care goals, which usually include a preference for home-based end-of-life care. More research is needed to confirm the efficacy of these programs, especially when disseminated on a large scale. Advanced Illness Management is one such program, implemented within a large open health system in northern California, USA.
To evaluate the impact of Advanced Illness Management on end-of-life resource utilization, cost of care, and care quality, as indicators of program success in supporting patient care goals.
A retrospective-matched observational study analyzing medical claims in the final 3 months of life.
SETTING/PARTICIPANTS: Medicare fee-for-service 2010-2014 decedents in northern California, USA.
Final month total expenditures for Advanced Illness Management enrollees ( N = 1352) were reduced by US$4824 (US$3379, US$6268) and inpatient payments by US$6127 (US$4874, US$7682). Enrollees also experienced 150 fewer hospitalizations/1000 (101, 198) and 1361 fewer hospital days/1000 (998, 1725). The percentage of hospice enrollees increased by 17.9 percentage points (14.7, 21.0), hospital deaths decreased by 8.2 percentage points (5.5, 10.8), and intensive care unit deaths decreased by 7.1 percentage points (5.2, 8.9). End-of-life chemotherapy use and non-inpatient expenditures in months 2 and 3 prior to death did not differ significantly from the control group.
Advanced Illness Management has a positive impact on inpatient utilization, cost of care, hospice enrollment, and site of death. This suggests that home-based support programs for people with advanced illness can be successful on a large scale in supporting personal end-of-life care choices.
针对晚期疾病患者的居家护理协调和支持计划与常规护理并行，以促进个人护理目标，这些目标通常包括在家中接受临终关怀。需要更多的研究来证实这些计划的疗效，特别是在大规模推广时。“晚期疾病管理”（Advanced Illness Management）就是这样一个项目，在美国加利福尼亚州北部的一个大型开放式医疗体系内实施。
评估“晚期疾病管理”对临终资源利用、护理成本和护理质量的影响，以此作为该项目支持患者护理目标的成功指标。
对 2010 年至 2014 年美国加利福尼亚州北部的医疗保险按服务项目付费的已故患者进行回顾性匹配的观察性研究。
地点/参与者：美国加利福尼亚州北部的医疗保险按服务项目付费的 2010-2014 年已故患者。
“晚期疾病管理”计划参与者（n=1352）在最后一个月的总支出减少了 4824 美元（3379 美元，6268 美元），住院支出减少了 6127 美元（4874 美元，7682 美元）。参与者的住院次数减少了 150 次/1000（101 次，198 次），住院天数减少了 1361 天/1000（998 天，1725 天）。入葬人数增加了 17.9 个百分点（14.7%，21.0%），医院死亡人数减少了 8.2 个百分点（5.5%，10.8%），重症监护病房死亡人数减少了 7.1 个百分点（5.2%，8.9%）。临终前 2 个月和 3 个月的临终化疗使用情况和非住院支出与对照组相比没有显著差异。
“晚期疾病管理”对住院利用、护理成本、葬服务入院率和死亡地点有积极影响。这表明，针对晚期疾病患者的居家支持计划在大规模推广时能够成功地支持个人的临终护理选择。
