Lou Lukas1, Carol Foltz, Hannah Paxton. 1. Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
Abstract
BACKGROUND: There is a growing need for palliative care services located outside of hospitals. OBJECTIVE: This study's objective was to evaluate a home-based, nonhospice, palliative medicine (PM) consultation practice within a fee-for-service environment. METHOD: Hospital and emergency department (ED) utilization and cost data obtained from administrative records were analyzed with longitudinal analyses to compare use 18 months before and after service enrollment in a single patient group. PARTICIPANTS: Patients (N=369) with advanced complex illness (ACI) referred for home-based palliative consultation participated in the study. INTERVENTION: Consultation conducted by nurse practitioners included a multidimensional assessment with recommendations to outpatient physicians for symptom management and guidance to patient and family for goals of treatment and advanced care planning (ACP). Nurse practitioners were supported by a collaborating PM physician. Follow-up visits varied by need for symptom management and ACP. RESULTS: Total hospitalizations, total hospital days, total and variable costs, and probability of a 30-day readmission were significantly reduced in the 18-month period following program enrollment. However, probability of an ED visit was not reduced. CONCLUSIONS: While requiring replication with rigorous methods, preliminary results suggest a home-based PM practice may reduce hospital utilization for ACI patients.
BACKGROUND: There is a growing need for palliative care services located outside of hospitals. OBJECTIVE: This study's objective was to evaluate a home-based, nonhospice, palliative medicine (PM) consultation practice within a fee-for-service environment. METHOD: Hospital and emergency department (ED) utilization and cost data obtained from administrative records were analyzed with longitudinal analyses to compare use 18 months before and after service enrollment in a single patient group. PARTICIPANTS: Patients (N=369) with advanced complex illness (ACI) referred for home-based palliative consultation participated in the study. INTERVENTION: Consultation conducted by nurse practitioners included a multidimensional assessment with recommendations to outpatient physicians for symptom management and guidance to patient and family for goals of treatment and advanced care planning (ACP). Nurse practitioners were supported by a collaborating PM physician. Follow-up visits varied by need for symptom management and ACP. RESULTS: Total hospitalizations, total hospital days, total and variable costs, and probability of a 30-day readmission were significantly reduced in the 18-month period following program enrollment. However, probability of an ED visit was not reduced. CONCLUSIONS: While requiring replication with rigorous methods, preliminary results suggest a home-based PM practice may reduce hospital utilization for ACI patients.
Authors: J Brian Cassel; Kathleen M Kerr; Donna K McClish; Nevena Skoro; Suzanne Johnson; Carol Wanke; Daniel Hoefer Journal: J Am Geriatr Soc Date: 2016-09-02 Impact factor: 5.562
Authors: Dana Lustbader; Mitchell Mudra; Carole Romano; Ed Lukoski; Andy Chang; James Mittelberger; Terry Scherr; David Cooper Journal: J Palliat Med Date: 2016-08-30 Impact factor: 2.947