Trinity Health, Livonia, Michigan.
Mount Carmel Hospice and Palliative Care, Columbus, Ohio.
J Palliat Med. 2019 Sep;22(9):1075-1081. doi: 10.1089/jpm.2018.0489. Epub 2019 Apr 5.
New population health community-based models of palliative care can result in more compassionate, affordable, and sustainable high-quality care. We evaluated utilization and cost outcomes of a standardized, population health community-based palliative care program provided by nurses and social workers. We conducted a retrospective propensity-adjusted study to quantify cost savings and resource utilization associated with a community-based palliative care program. We analyzed claims data from a Medicare Advantage (MA) plan and used a proprietary predictive model to identify 804 members at high risk for overmedicalized end-of-life care. We enrolled 204 members in the palliative care program and compared them with 600 who received standard, telephonic, health plan case management. We excluded members with fewer than two months of enrolled experience or those with insufficient data for analysis, leaving 176 members in the study group and 570 in the control group for evaluation. We compared differences in utilization and costs (medical and pharmacy), hospital admissions, bed days (acute and intensive care unit [ICU]), and emergency department visits. A 30,000-member MA plan and a health system in Central Ohio between October 2015 and June 2016. Members who received community-based palliative care showed a statistically significant 20% reduction in total medical costs ($619 per enrolled member per month), 38% reduction in ICU admissions, 33% reduction in hospital admissions, and 12% reduction in hospital days. A structured nurse and social work model of community-based palliative care using a predictive model to identify MA candidates for intervention can reduce utilization and medical costs.
新的以人群为基础的姑息治疗社区模式可以提供更有同情心、更负担得起、更可持续的高质量护理。我们评估了由护士和社会工作者提供的标准化、以人群为基础的姑息治疗社区计划的利用情况和成本结果。我们进行了一项回顾性倾向调整研究，以量化与社区为基础的姑息治疗计划相关的成本节约和资源利用。我们分析了医疗保险优势（MA）计划的索赔数据，并使用专有的预测模型来确定 804 名高风险过度医疗临终关怀的成员。我们招募了 204 名姑息治疗计划的成员，并将他们与接受标准电话健康计划病例管理的 600 名成员进行了比较。我们排除了参加经验不足两个月或分析数据不足的成员，在研究组中有 176 名成员，对照组中有 570 名成员进行评估。我们比较了利用和成本（医疗和药房）、住院、床位（急性和重症监护病房[ICU]）和急诊就诊的差异。2015 年 10 月至 2016 年 6 月，在俄亥俄州中部的一个拥有 30,000 名成员的 MA 计划和一个卫生系统中进行了这项研究。接受以社区为基础的姑息治疗的成员在总医疗费用（每月每位登记成员 619 美元）方面显示出统计学上显著的 20%降低，重症监护病房入院率降低 38%，住院人数减少 33%，住院天数减少 12%。使用预测模型来确定 MA 候选者进行干预的基于社区的姑息治疗的结构化护士和社会工作者模式可以减少利用和医疗成本。
