Effect of a Home-Based Palliative Care Program on Healthcare Use and Costs.
Effect of a Home-Based Palliative Care Program on Healthcare Use and Costs.
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家庭姑息治疗计划对医疗保健使用和成本的影响。
DOI：
10.1111/jgs.14354
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发表时间：
2016-11
影响因子：
6.3
通讯作者：
Hoefer D
中科院分区：
文献类型：
--
作者：
Brian Cassel J;Kerr KM;McClish DK;Skoro N;Johnson S;Wanke C;Hoefer D
评估由医疗保险优势计划受益人资助和运营的前瞻性姑息治疗项目的非临床结果。采用基于倾向匹配的观察性、回顾性研究。南加州的卫生系统。2007年至2014年间接受干预的个体（n = 368）与癌症、慢性阻塞性肺病、心力衰竭和痴呆四种疾病组中的1075名对照个体相匹配。所有人在回顾性研究时都已知已经死亡，是医疗保险优惠受益人，并且在死亡前有2年的使用数据。每个疾病组的中位死亡年龄都大于80岁。多学科团队提供的基于家庭和诊所的姑息治疗（PC）服务。结果包括住院费用、其他医疗费用、再入院率、住院和住院天数、生命最后30天内重症监护病房的使用情况以及入院后30天内的死亡情况。所有四种疾病组的干预参与者都有更少的医院使用和更低的住院费用，而非干预参与者则降低了总体医疗费用。在生命的最后6个月，干预组的医疗保健费用每月基本保持不变，而比较组的费用急剧增加。在另一种支付模式的背景下，提供者“有风险”承担护理费用，积极主动的个人电脑计划有助于避免医院使用的升级和生命最后几个月常见的费用。
To evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries. Observational, retrospective study using propensity‐based matching. A health system in southern California. Individuals who received the intervention between 2007 and 2014 (n = 368) were matched with 1,075 comparison individuals within each of four disease groups: cancer, chronic obstructive pulmonary disease, heart failure, and dementia. All were known to be dead at the time of the retrospective study, were Medicare Advantage beneficiaries, and had 2 years of usage data before death. Median age at death for each disease group was older than 80. Home‐ and clinic‐based palliative care (PC) services provided by a multidisciplinary team. Outcomes included hospital costs, other healthcare costs, readmission rates, hospital admissions and bed days, intensive care unit use in final 30 days of life, and death within 30 days of an admission. Intervention participants in all four disease groups had less hospital use and lower hospital costs nonintervention participants, which drove lower overall healthcare costs. In the final 6 months of life, healthcare costs for the intervention groups stayed largely the same from month to month, whereas costs for comparison participants increased dramatically. In the context of an alternative payment model in which the provider was “at risk” of bearing the costs of care, a proactive PC program helped to avoid the escalation in hospital use and costs commonly seen in the final months of life.
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影响因子：
120.7
作者：
Teno, Joan M.;Gozalo, Pedro L.;Bynum, Julie P. W.;Leland, Natalie E.;Miller, Susan C.;Morden, Nancy E.;Scupp, Thomas;Goodman, David C.;Mor, Vincent
通讯作者：
Mor, Vincent
影响因子：
6.3
作者：
Edes, Thomas;Kinosian, Bruce;Hossain, Monir
通讯作者：
Hossain, Monir
影响因子：
45.3
作者：
Bakitas, Marie A.;Tosteson, Tor D.;Ahles, Tim A.
通讯作者：
Ahles, Tim A.
特定疾病的预科护理计划干预对临终护理的影响。
影响因子：
6.3
作者：
Kirchhoff KT;Hammes BJ;Kehl KA;Briggs LA;Brown RL
通讯作者：
Brown RL
影响因子：
2
作者：
Austin, Peter C.
通讯作者：
Austin, Peter C.