Claire K Ankuda1, Diane E Meier1,2. 1. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai. 2. The Center to Advance Palliative Care, New York, New York, USA.
Abstract
PURPOSE OF REVIEW: Care near the end of life is expensive and frequently not aligned with the expressed preferences of decedents, creating an opportunity to improve value, or increase quality while lowering cost. This review examines publications from 2017 and 2018 on interventions and policies associated with high-value end-of-life care. Innovations in video and web-based advance care planning are promising to improve preference-congruent care at low cost. RECENT FINDINGS: The patterns of care within hospice and in particular increased investment in patient care in hospice are shown to improve value. A meta-analysis demonstrated the role of inpatient palliative care consultations in decreasing hospitalization costs, as did several studies on inpatient palliative care units. Internationally, a range of home-based palliative care programs, implemented at the population level, demonstrated cost savings and reduced intensive care near the end of life. Finally, public policies that funded medical and long-term care and address broader inequalities were demonstrated to decrease low-value care near the end of life. SUMMARY: This review demonstrates the efficacy of a range of approaches to improve value of care at the end of life, both within the health system and across public policy sectors.
PURPOSE OF REVIEW: Care near the end of life is expensive and frequently not aligned with the expressed preferences of decedents, creating an opportunity to improve value, or increase quality while lowering cost. This review examines publications from 2017 and 2018 on interventions and policies associated with high-value end-of-life care. Innovations in video and web-based advance care planning are promising to improve preference-congruent care at low cost. RECENT FINDINGS: The patterns of care within hospice and in particular increased investment in patient care in hospice are shown to improve value. A meta-analysis demonstrated the role of inpatient palliative care consultations in decreasing hospitalization costs, as did several studies on inpatient palliative care units. Internationally, a range of home-based palliative care programs, implemented at the population level, demonstrated cost savings and reduced intensive care near the end of life. Finally, public policies that funded medical and long-term care and address broader inequalities were demonstrated to decrease low-value care near the end of life. SUMMARY: This review demonstrates the efficacy of a range of approaches to improve value of care at the end of life, both within the health system and across public policy sectors.
Authors: Natalie P Plick; Claire K Ankuda; Christine A Mair; Mohammed Husain; Katherine A Ornstein Journal: J Am Geriatr Soc Date: 2021-04-21 Impact factor: 7.538
Authors: Amanda J Reich; Ginger Jin; Avni Gupta; Dae Kim; Stuart Lipstiz; Holly G Prigerson; Jennifer Tjia; Keren Ladin; Scott D Halpern; Zara Cooper; Joel S Weissman Journal: PLoS One Date: 2020-02-05 Impact factor: 3.240