Weinstein Elizabeth, Kemmann Matthew, Douglas Sara L, Daly Barbara, Levitan Nathan
Cleveland Clinic Foundation, Cleveland, OH, USA.
University Hospitals of Cleveland, Cleveland, OH, USA.
Support Care Cancer. 2022 Jan;30(1):535-542. doi: 10.1007/s00520-021-06450-z. Epub 2021 Aug 1.
This article reports findings from a demonstration project funded by the Center for Medicare and Medicaid Innovation (CMMI). The purpose of the project was to test a supportive care program on the outcomes of quality of care and quality of life, and costs in patients with advanced cancer.
The project was conducted between February 2015 and February 2018, enrolling adult, Medicare or Medicaid beneficiaries with advanced or progressed solid tumor malignancy. A comparative longitudinal comparison of the program with both a concurrent control and an historic control was used to evaluate outcomes. The intervention included routine electronic biopsychosocial screening, early access to specialty palliative care, and nurse care coordination. Quality of life, aggressiveness of care, and healthcare utilization were measured.
A total of 1340 people were enrolled, with 71% of the total sample being Caucasian; 41.4% had stage IV cancer, and 20% utilized Medicaid only. Significant differences in the enrolled patients and the comparison group were controlled for through statistical analysis. There were significantly fewer ED visits, unplanned admissions, and fewer total hospitalization days in the intervention group. In the last 30 days of life, hospital and ICU admissions were less and a greater proportion of patients were enrolled in hospice in the intervention group. Quality of life had a marked improvement for enrolled patients. Average cost per member per month was not less in the enrolled group.
This pragmatic demonstration project confirmed the clinical benefits of an integration of supportive care for patients with advanced cancer, although no reduction in costs was found.
本文报告了一项由医疗保险和医疗补助创新中心（CMMI）资助的示范项目的研究结果。该项目的目的是测试一项支持性护理计划对晚期癌症患者的护理质量、生活质量和成本的影响。
该项目于2015年2月至2018年2月进行，招募患有晚期或进展期实体瘤恶性肿瘤的成年医疗保险或医疗补助受益人。通过将该计划与同期对照和历史对照进行比较纵向比较来评估结果。干预措施包括常规电子生物心理社会筛查、早期获得专科姑息治疗以及护士护理协调。对生活质量、积极治疗程度和医疗保健利用率进行了测量。
共招募了1340人，样本总数的71%为白种人；41.4%患有IV期癌症，20%仅使用医疗补助。通过统计分析控制了入组患者与对照组之间的显著差异。干预组的急诊就诊次数、非计划住院次数和总住院天数显著减少。在生命的最后30天，干预组的医院和重症监护病房住院人数较少，且有更大比例的患者接受了临终关怀。入组患者的生活质量有显著改善。入组组的人均每月平均成本并未降低。
这项务实的示范项目证实了对晚期癌症患者综合支持性护理的临床益处，尽管未发现成本有所降低。
