1 Division of Geriatrics, General Internal Medicine and Palliative Medicine, University of Arizona College of Medicine , Phoenix, Arizona.
2 Department of Pharmacy, Banner University Medical Center , Phoenix, Arizona.
J Palliat Med. 2018 Sep;21(9):1272-1277. doi: 10.1089/jpm.2017.0375. Epub 2018 Jun 29.
The success of our hospital-based Palliative Care program stimulated requests to duplicate the program across the health system continuum of care.
To develop a model of care focused on a high-need, high-cost population that could be implemented across all care settings, including hospitals and patients' homes.
To fiscally support program expansion from hospital to home, we conducted a retrospective cost analysis for home-based Palliative Care (HBPC)-enrolled patients with continuous claims months before program enrollment through date of death. The HBPC enrollees were evaluated against a cohort group of CMS (Centers for Medicare & Medicaid Service) and Medicare Advantage patients who did not participate in the HBPC program (n = 3135). Twenty-one months of claims leading up to the date of death were evaluated for both populations. The analysis was designed to test whether Palliative Care patients demonstrated less overall claims expense and service utilization in the same periods as patients without Palliative Care. Claim months were grouped into three-month clusters for evaluation and statistical testing of per member per month utilization and cost.
Overall, HBPC patients demonstrated significantly less service utilization and cost in the months leading up to death. Cost differences were primarily driven by clear cost divergence in the last three months of life [$9,843 (PC) vs. $27,530 (C)]. Our program grew from a hospital-based program to include the establishment of a home-based program.
Palliative Care programs can successfully expand outside hospital walls to serve a high need/high-cost patient population.
我们医院姑息治疗项目的成功激发了在整个医疗系统连续护理中复制该项目的需求。
开发一种以高需求、高成本人群为重点的护理模式，可在所有护理环境中实施，包括医院和患者家中。
为了从医院到家庭为项目的扩展提供财政支持，我们对参加家庭姑息治疗（HBPC）的患者进行了回顾性成本分析，这些患者在参加 HBPC 计划之前的连续索赔月份，通过死亡日期。将 HBPC 参与者与 CMS（医疗保险和医疗补助服务中心）和 Medicare Advantage 患者的队列组进行了评估，这些患者没有参加 HBPC 计划（n=3135）。对这两个群体在死亡日期前的 21 个月的索赔进行了评估。该分析旨在测试姑息治疗患者在与没有姑息治疗的患者相同的时间段内是否表现出总体索赔费用和服务利用率较低。索赔月份被分为三个月的簇进行评估，并对每个成员每个月的使用和成本进行统计测试。
总体而言，HBPC 患者在死亡前的几个月中表现出明显较少的服务利用和成本。成本差异主要是由于生命最后三个月的明显成本差异[9843 美元（PC）与 27530 美元（C）]。我们的项目从一个基于医院的项目扩展到包括一个基于家庭的项目。
姑息治疗项目可以成功地扩展到医院墙外，为高需求/高成本的患者群体服务。
