Impact of home-based,patient-centered support for people with advanced illness in an open health system: A retrospective claims analysis of health expenditures,utilization,and quality of care at end of life

Abstract

Background:

Home-based care coordination and support programs for people with advanced illness work alongside usual care to promote personal care goals, which usually include a preference for home-based end-of-life care. More research is needed to confirm the efficacy of these programs, especially when disseminated on a large scale. Advanced Illness Management is one such program, implemented within a large open health system in northern California, USA.

Aim:

To evaluate the impact of Advanced Illness Management on end-of-life resource utilization, cost of care, and care quality, as indicators of program success in supporting patient care goals.

Design:

A retrospective-matched observational study analyzing medical claims in the final 3 months of life.

Setting/participants:

Medicare fee-for-service 2010–2014 decedents in northern California, USA.

Results:

Final month total expenditures for Advanced Illness Management enrollees (N = 1352) were reduced by US$4824 (US$3379, US$6268) and inpatient payments by US$6127 (US$4874, US$7682). Enrollees also experienced 150 fewer hospitalizations/1000 (101, 198) and 1361 fewer hospital days/1000 (998, 1725). The percentage of hospice enrollees increased by 17.9 percentage points (14.7, 21.0), hospital deaths decreased by 8.2 percentage points (5.5, 10.8), and intensive care unit deaths decreased by 7.1 percentage points (5.2, 8.9). End-of-life chemotherapy use and non-inpatient expenditures in months 2 and 3 prior to death did not differ significantly from the control group.

Conclusion:

Advanced Illness Management has a positive impact on inpatient utilization, cost of care, hospice enrollment, and site of death. This suggests that home-based support programs for people with advanced illness can be successful on a large scale in supporting personal end-of-life care choices.

Keywords

End-of-life care health expenditures quality of healthcare patient-centered care delivery of healthcare integrated administrative claims healthcare

Get full access to this article

View all access options for this article.

References

Center to Advance Palliative Care. Growth of palliative care in U.S. hospitals: 2013, http://www.capc.org/capc-growth-analysis-snapshot-2013.pdf

Teno

Gozalo

Bynum

JPW

et al . Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA 2013; 309(5):470–477.

Hogan

Lunney

Gabel

et al . Medicare beneficiaries’ costs of care in the last year of life. Health Aff Proj Hope 2001; 20(4): 188–195.

Barnato

McClellan

Kagay

et al . Trends in inpatient treatment intensity among Medicare beneficiaries at the end of life. Health Serv Res 2004; 39(2): 363–375.

Eppig

Last year of life expenditures.Centers for Medicare & Medicaid Services, 2003, https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Downloads/OLD/issue10.pdf

. End of life care: medical treatments and costs by age, race, and region.HSR&D study IIR 02–189, http://www.hsrd.research.va.gov/research/abstracts/IIR_02–;189.htm

Kerr

Tangeman

Rudra

et al . Clinical impact of a home-based palliative care program: a hospice-private payer partnership. J Pain Symptom Manage 2014; 48(5): 883–892.e1.

Engelhardt

McClive-Reed

Toseland

et al . Effects of a program for coordinated care of advanced illness on patients, surrogates, and healthcare costs: a randomized trial. Am J Manag Care 2006; 12(2): 93–100.

Seow

Piet

Kenworthy

et al . Evaluating a palliative care case management program for cancer patients: the omega life program. J Palliat Med 2008; 11(10): 1314–1318.

10.

Chen

Thorsteinsdottir

Cha

et al . Health care outcomes and advance care planning in older adults who receive home-based palliative care: a pilot cohort study. J Palliat Med 2014; 18(1): 38–44.

11.

Aiken

Butner

Lockhart

et al . Outcome evaluation of a randomized trial of the PhoenixCare intervention: program of case management and coordinated care for the seriously chronically ill. J Palliat Med 2006; 9(1): 111–126.

12.

Ciemins

Stuart

Gerber

et al . An evaluation of the Advanced Illness Management (AIM) Program: increasing hospice utilization in the San Francisco Bay area. J Palliat Med 2006; 9(6): 1401–1411.

13.

Charlson

Pompei

Ales

et al . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40(5): 373–383.

14.

Quan

Sundarajan

Halfon

et al . Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43(11): 1130–1139.

15.

Sekhon

JS.

Multivariate and propensity score matching software with automated balance optimization: the matching package for R. J Stat Softw 2011; 42(7): 1–52.

16.

Sekhon

Grieve

RD.

A matching method for improving covariate balance in cost-effectiveness analyses. Health Econ 2012; 21(6): 695–714.

17.

Austin

PC.

Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat 2009; 38(6): 1228–1234.

18.

http://www.resdac.org/

19.

Abadie

Imbens

GW.

On the failure of the bootstrap for matching estimators. Econometrica 2008; 76(6): 1537–1557.

20.

Austin

PC.

A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med 2008; 27(12): 2037–2049.

21.

Obermeyer

Makar

Abujaber

et al . Association between the Medicare hospice benefit and health care utilization and costs for patients with poor-prognosis cancer. JAMA 2014; 312(18): 1888–1896.

22.

Zuckerman

Stearns

Sheingold

et al . Medicare spending at the end of life. J Gerontol B Psychol Sci Soc Sci 2016; 71(3): 569–580.

23.

Kleinpell

Vasilevskis

Fogg

et al . Exploring the association of hospice care on patient experience and outcomes of care. BMJ Support Palliat Care Published Online First: 16 August 2016. doi: 10.1136/bmjspcare-2015-001001.

24.

Teno

Clarridge

Casey

et al . Family perspectives on end-of-life care at the last place of care. JAMA 2004; 291(1): 88–93.

25.

Parker

Remington

Nannini

et al . Patient outcomes and satisfaction with care following palliative care consultation. J Hosp Palliat Nurs 2013; 15(4): 225–232.

26.

Krumholz Harlan

Nuti Sudhakar

Downing Nicholas et al . Mortality, hospitalizations, and expenditures for the Medicare population aged 65 years or older, 1999–2013. JAMA 2015; 314(4): 355–365.

27.

Weeks

Catalano

Cronin

et al . Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med 2012; 367(17): 1616–1625.

28.

Campbell

Guzman

JA.

Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest 2003; 123(1): 266–271.

29.

Gade

Venohr

Conner

et al . Impact of an inpatient palliative care team: a randomized control trial. J Palliat Med 2008; 11(2): 180–190.

30.

Norton

Hogan

Holloway

et al . Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med 2007; 35(6): 1530–1535.