Background: In the Medicare population, end-of-life care is fragmented and hospice is underutilized.
Evidence suggests that hospice care is associated with increased patient/family
satisfaction and reductions in overall health care costs. Advanced Illness Management (AIM)
is a home-based program established to ease the transition between curative and comfort care
for seriously ill patients who lack coordinated hospital, home health, and hospice care.
Objective: Measure the impact of the AIM program on the discharge disposition of participating
home health patients.
Design: Retrospective cohort study.
Setting/subjects: A total of 435 patients who received home health services through the Sutter
Visiting Nurse Association and Hospice (SVNA&H) and who were discharged between
2003 and September 2005 were included in this study. Participants were selected based on a
life expectancy of 6 months or less and additionally matched on prognosis of current episode
of illness and symptom status. Intervention patients were compared to those receiving usual
home health care at two SVNA&H branches.
Results: In the within-branch comparison, a 28% difference was observed in the number of
hospice referrals between patients who received the AIM intervention and Usual Care I (47%
AIM; 33% UCI, p = 0.003). When patients receiving the AIM intervention were compared to
patients from another branch, Usual Care II, a 67% difference emerged (47% AIM; 16% UCII,
p < 0.0001). Among African American patients, 60% and 73% more patients were referred to
hospice when AIM patients were compared to Usual Care I and Usual Care II patients, respectively
(p < 0.01). These differences persisted after controlling for symptom status, patient
demographics and home health length of stay.
Conclusions: The AIM program was successful at increasing hospice utilization through a
targeted intervention focused on palliative and end-of-life care, increased patient education
and decision making, and a dynamic treatment approach. The finding of increased utilization
by African Americans, a population traditionally reluctant to use hospice, was particularly
noteworthy.
