agilon health (K.R., B.K.), Boston, Massachusetts, USA.
Brookdale Department of Geriatrics and Palliative Medicine (N.E.G.), Icahn School of Medicine, New York City, New York USA.
J Pain Symptom Manage. 2024 Mar;67(3):195-203. doi: 10.1016/j.jpainsymman.2023.11.006. Epub 2023 Nov 14.
Faced with a projected shortage of specialized palliative care physicians, scalable palliative solutions are required to better meet the aging population's needs.
To determine whether a multi-site, primary care-led, integrated palliative care model improves clinical, utilization, and economic outcomes.
Propensity score-matched comparison group formed from participants who were Medicare beneficiaries, died January 1, 2021-January 31, 2023, were patients of eight primary care practices that partner with agilon health, and enrolled in palliative care for at least seven days. Each practice operates in a value-based model, where primary care providers (PCPs) take on full-risk for the cost and quality of patient outcomes. Each program includes symptom management, defining goals of care/advance directives, PCP care coordination, and assistance with care transitions if patients enroll in hospice.
Final sample included 1778 decedents, with 889 in both enrolled and matched cohorts, average age 83. Palliative care is associated with improved patient outcomes from palliative care enrollment until death, including 5.4 more days at home (p < 0.001), 0.4 fewer hospitalizations (p < 0.001), 17% fewer deaths in a hospital (p < 0.001), and $10,393 lower overall healthcare costs (p < 0.001).
A primary care-led, integrated approach of delivering palliative care within a full-risk model can be an effective care delivery mechanism to meet the healthcare needs of an aging population by impacting patient outcomes and reducing avoidable utilization and cost at the end of life. These findings demonstrate that PCPs in a scaled, full-risk model can simultaneously improve care for patients while reducing costs to the healthcare system.
面对专业姑息治疗医生短缺的问题，需要可扩展的姑息治疗解决方案，以更好地满足老龄化人口的需求。
确定多地点、以初级保健为主导、综合姑息治疗模式是否能改善临床、利用和经济结果。
从 Medicare 受益人的参与者中确定倾向评分匹配的对照组，这些参与者于 2021 年 1 月 1 日至 2023 年 1 月 31 日死亡，是与 agilon health 合作的 8 个初级保健实践的患者，并至少接受了 7 天的姑息治疗。每个实践都在基于价值的模式下运作，其中初级保健提供者（PCP）承担患者成本和结果质量的全部风险。每个项目都包括症状管理、确定医疗保健目标/预先指示、PCP 护理协调以及患者如果参加临终关怀计划的护理过渡协助。
最终样本包括 1778 名死者，其中有 889 人在注册组和匹配组中，平均年龄为 83 岁。姑息治疗与姑息治疗登记至死亡期间患者结果的改善相关，包括在家中多 5.4 天（p < 0.001）、住院次数少 0.4 次（p < 0.001）、在医院死亡人数少 17%（p < 0.001）和整体医疗保健费用少 10393 美元（p < 0.001）。
在全面风险模式下，以初级保健为主导、综合的姑息治疗方法可以成为满足老龄化人口医疗保健需求的有效护理提供机制，通过影响患者结果和减少临终时的不必要利用和成本。这些发现表明，在规模化、全面风险模式下的 PCP 可以在改善患者护理的同时降低医疗保健系统的成本。
