Impact of Palliative Care on Healthcare Utilization of Seriously Ill Older Adults

姑息治疗对重病老年人医疗保健利用的影响

• 批准号: 8340905
• 负责人: Laura Pilar Gelfman
• 金额: $ 8.48万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8340905
• 关键词: 18 year old; Address; Admission activity; Adult; Age; Aged, 80 and over; Caring; Cause of Death; Chronic Disease; Clinical; Cohort Studies; Comorbidity; Consultations; Cost Savings; Data; Data Analyses; Data Set; Databases; Diagnosis; Disease; Elderly; Elements; Enrollment; Expenditure; Future; Goals; Health Care Costs; Heart failure; Hospital Costs; Hospitalization; Hospitals; Incidence; Intensive Care Units; Intervention; Leadership; Length of Stay; Life; Malignant Neoplasms; Marketing; Medical; Medicare; Methods; Outcome; Pain; Palliative Care; Patients; Policies; Population; Quality of Care; Symptoms; Translating; United States; cohort; cost; experience; health care service utilization; hospice environment; human old age (65+); improved; meetings; mortality; older patient; outcome forecast; prospective; treatment as usual

DESCRIPTION (provided by applicant): Background: Heart failure (HF) is a chronic illness typically associated with multiple co-morbidities. Nearly 6 million people have HF, with the incidence approaching 1 in 100 adults over the age of 65. HF is the most common cause of hospitalization among adults over the age of 65 and admission rates for this disease have increased steadily over the last two decades. Even with current therapies, HF patients experience high symptom burden and mortality over the course of a prolonged and unpredictable illness. Symptomatic HF confers a worse prognosis than most cancers, with a one-year mortality of approximately 45 percent. Despite these numbers, less than 10% of patients with HF receive any form of palliative care; as of 2007, less than 12% of hospice admissions were patients with HF. Unlike the growing evidence of the benefits of palliative care for patients with cancer, there is a paucity of data regarding the potential benefit of an early palliative care intervention for older patients with HF. Palliative care has the potential to improe clinical outcomes for older patients facing HF by improving pain and other symptom control, clarifying goals of care, and guiding treatment decisions to meet goals. We hypothesize that these elements will translate into reduced healthcare utilization and cost. Objective: The goal of this proposal is to assess better the effect of palliative care consultation on utilization and coss of older adults with HF. Specific Aim 1: To compare the difference in healthcare utilization, including costs of hospitalization, length of stay, number of days in the intensive care unit (ICU) number of rehospitalizations and hospice enrollment at discharge among older patients with HF who received palliative care and those who received usual care. Specific Aim 2: To determine differences in healthcare utilization (as above) between younger (<65 years), older (65 to 84 years), and the oldest old (>85 years) patients with HF who received palliative care and those who received usual care. Methods: To address these aims, a secondary data analysis will be performed of the Palliative Care Leadership Center's (PCLC) Outcomes database, a unique database of hospital administrative and cost data from 8 geographically and structurally diverse hospitals representing low-, middle, and high-cost markets served by 6 palliative care consultation teams. The dataset includes hospital administrative data of patients aged 18 years or older with lengths of stay from 7 to 30 days between 2002 and 2004 who received palliative care and those who did not. Discussion: Data comparing the healthcare utilization of younger, older, and oldest old patients with HF will guide when palliative care will have the greatest benefit and direct policy efforts to improve quality of care and minimize healthcare cost. The results of this study will inform a future prospective cohort study comparing symptoms, survival and healthcare utilization for hospitalized older adults with HF who receive palliative care consultation with those who do not. This will create a better understanding of the benefits of palliative care to this population - a key first step in improving the quality of care for older adlts with HF. PUBLIC HEALTH RELEVANCE: Because heart failure (HF) is a disease of older adults, with more Medicare dollars spent on the diagnosis and treatment of HF than any other diagnosis, it is critical to gain an understanding of how palliative care can be directed to best care for this population of older patients living with HF. By understanding these differences in healthcare utilization and cost for older patients, an early palliative care consultation can effectively targt the different population segments of older adults and thereby, have significant Medicare implications for improving quality of care and minimizing cost of care.

描述（由申请人提供）：背景：心力衰竭（HF）是一种慢性疾病，通常与多种合并症有关。近600万人患有HF，在65岁以上的100名成年人中有1人中有1人。HF是65岁以上成年人住院的最常见原因，在过去的二十年中，这种疾病的入院率稳步增长。即使有当前的疗法，HF患者在长期且无法预测的疾病过程中也会承受高症状负担和死亡率。有症状的HF比大多数癌症的预后更糟糕，一年的死亡率约为45％。尽管有这些数字，但不到10％的HF患者接受了任何形式的姑息治疗。截至2007年，不到12％的临终关怀入院是HF患者。与越来越多的证据表明姑息治疗对癌症患者的益处，关于早期姑息治疗干预措施的潜在益处的数据很少。姑息治疗有可能通过改善疼痛和其他症状控制，澄清护理目标以及指导治疗决策以实现目标来为面对HF的老年患者提供临床结果。我们假设这些要素将转化为医疗保健利用率和成本的降低。目的：该提案的目的是更好地评估姑息治疗咨询对HF老年人使用和COSS的影响。具体目的1：比较医疗保健利用的差异，包括住院费用，住院时间，重症监护室的天数（ICU）的数量（ICU）重新住院数量和接受姑息治疗的HF患者的出院时的重新住院数量和临终关怀入学率以及接受常规护理的人。具体目的2：确定年轻（<65岁），年龄较大（65至84岁）和最古老的HF患者接受姑息治疗和接受常规护理的HF患者的医疗保健利用（如上上述）差异（如上所述）。方法：为了解决这些目标，将对姑息治疗领导力中心（PCLC）的结果数据库进行二次数据分析，这是一个独特的医院行政和成本数据数据库，来自8家代表6个palliative Care咨询团队服务的低，中间和高成本市场的地理位置和结构上多样化的医院。该数据集包括在2002年至2004年之间从7到30天住院的18岁或30天的患者的医院行政数据，他们接受了姑息治疗，而没有接受过姑息治疗。讨论：比较年轻，年长和最古老的HF患者的医疗保健利用的数据将指导姑息治疗将获得最大的好处和直接政策努力，以提高护理质量并最大程度地降低医疗保健成本。这项研究的结果将为一项未来的前瞻性队列研究提供依据，比较住院的HF症状，生存和医疗保健利用，他们与不这样做的人进行姑息治疗咨询。这将更好地理解姑息治疗对这个人群的好处，这是提高HF较老的ADLT护理质量的关键第一步。 公共卫生相关性：由于心力衰竭（HF）是老年人的疾病，与其他任何诊断相比，在HF诊断和治疗上花费了更多的Medicare美元，因此了解如何将姑息治疗的方式用于如何为这类患有HF的老年患者最好地护理姑息治疗。通过了解医疗保健利用的这些差异和老年患者的成本，早期的姑息治疗咨询可以有效地targt targt老年人的不同人口细分，从而对提高护理质量和最小化护理成本具有重要意义。