Akhtar Saad, Srinivasan Vamshek, Weisse Carol, DiSorbo Phil
Albany Medical College, Albany, NY, USA.
Psychology Department, Union College, Schenectady, NY, USA.
Am J Hosp Palliat Care. 2020 Mar;37(3):196-200. doi: 10.1177/1049909119872486. Epub 2019 Sep 2.
The holistic and multidisciplinary approach of in-home palliative care (IHPC) is known to offer high-quality and cost-effective care for patients at the end of life. However, the financial benefits of upstream IHPC programs to hospitals, patients, and payers have not been fully characterized for patients with comorbid chronic conditions.
To characterize the financial benefits that upstream IHPC offers to patients with multiple chronic conditions.
A structured retrospective patient record review was conducted on the number of emergency department (ED) visits, number of inpatient hospitalizations, hospital length of stay (LOS), and payments made to the hospital for all patients (N = 71) enrolled in an IHPC program between January 1, 2016, and June 30, 2016. Discharge history from each patient's medical record was also assessed. Comparisons were drawn between patients' LOS on IHPC and an equivalent time period prior to enrollment in IHPC.
After patients enrolled in IHPC, average ED and inpatient utilization declined significantly by 41% ( = .01) and 71% ( < .001), respectively. The payers for health-care services realized a significant decline of US$2,201 ( < .001) in hospital payments per patient per month. Inpatient LOS was also significantly lower than expected once patients enrolled in the program ( = .01).
As the need for chronic disease management continues to grow, managers of health systems, managed care organizations, and home health agencies should be cognizant of the financial value that IHPC has to offer.
居家姑息治疗（IHPC）的整体和多学科方法已知可为临终患者提供高质量且具成本效益的护理。然而，对于患有慢性合并症的患者，上游IHPC项目给医院、患者和支付方带来的经济益处尚未得到充分描述。
描述上游IHPC为患有多种慢性病的患者带来的经济益处。
对2016年1月1日至2016年6月30日期间参加IHPC项目的所有患者（N = 71）的急诊就诊次数、住院次数、住院时长（LOS）以及医院获得的支付进行了结构化回顾性患者病历审查。还评估了每位患者病历中的出院记录。对患者在接受IHPC期间的LOS与参加IHPC之前的同等时间段进行了比较。
患者参加IHPC后，急诊和住院的平均利用率分别显著下降了41%（P = .01）和71%（P < .001）。医疗服务支付方每月每位患者的医院支付显著下降了2201美元（P < .001）。一旦患者参加该项目，住院LOS也显著低于预期（P = .01）。
随着慢性病管理需求持续增长，卫生系统管理者、管理式医疗组织和家庭健康机构应认识到IHPC所能带来的经济价值。
