Supporting choice: an innovative model of integrated palliative care funded by a private health insurer.
community care
death
delivery of healthcare
end-of-life care
palliative care
preferred place of death
Journal
Internal medicine journal
ISSN: 1445-5994
Titre abrégé: Intern Med J
Pays: Australia
ID NLM: 101092952
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
04
06
2019
revised:
12
08
2019
accepted:
13
08
2019
pubmed:
20
8
2019
medline:
28
4
2021
entrez:
20
8
2019
Statut:
ppublish
Résumé
The number of Australians dying each year is predicted to double in the next 25 years and there is an urgent need to establish sustainable models for providing high quality end-of-life care. An innovative community care model (Bupa Palliative Care Choices Program or BPCCP) was developed and piloted with the purpose of supporting patients in achieving their choices surrounding end-of-life care. This study evaluates whether BPCCP patients were more likely to die in their place of choice compared with patients receiving standard care. Additional aims were evaluating patient and carer satisfaction and insurer cost. This prospective, comparative cohort study comprises a clinical chart audit and survey of patient and carer experience. More BPCCP participants preferred to die at home (53% vs 31%). A lower proportion of BPCCP patients died in acute hospitals (10% vs 19%) and more of this cohort died at home (46% vs 26%). In both cohorts, nearly 90% of patients were able to die in their preferred location. Patient and carer satisfaction with the programme was very high in the small cohort who responded to the survey. There was a decrease in average claims spend per patient enrolled in the programme during the first 12-month period of implementation compared with historical claims spend for inpatients only. This evaluation of an innovative community palliative care intervention indicates that the extra services available to patients support the choice of dying at home and the ability to do so while generating claims cost efficiencies.
Sections du résumé
BACKGROUND
The number of Australians dying each year is predicted to double in the next 25 years and there is an urgent need to establish sustainable models for providing high quality end-of-life care. An innovative community care model (Bupa Palliative Care Choices Program or BPCCP) was developed and piloted with the purpose of supporting patients in achieving their choices surrounding end-of-life care.
AIMS
This study evaluates whether BPCCP patients were more likely to die in their place of choice compared with patients receiving standard care. Additional aims were evaluating patient and carer satisfaction and insurer cost.
METHODS
This prospective, comparative cohort study comprises a clinical chart audit and survey of patient and carer experience.
RESULTS
More BPCCP participants preferred to die at home (53% vs 31%). A lower proportion of BPCCP patients died in acute hospitals (10% vs 19%) and more of this cohort died at home (46% vs 26%). In both cohorts, nearly 90% of patients were able to die in their preferred location. Patient and carer satisfaction with the programme was very high in the small cohort who responded to the survey. There was a decrease in average claims spend per patient enrolled in the programme during the first 12-month period of implementation compared with historical claims spend for inpatients only.
CONCLUSIONS
This evaluation of an innovative community palliative care intervention indicates that the extra services available to patients support the choice of dying at home and the ability to do so while generating claims cost efficiencies.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
931-937Informations de copyright
© 2019 Royal Australasian College of Physicians.
Références
The 2015 Quality of Death Index: ranking palliative care across the world. A report by The Economist Intelligence Unit. 2015.
Urbis. Evaluation of the national palliative care strategy 2010. Final report. Sydney; 2016.
Swerissen H, Duckett S. Dying Well. Carlton: Grattan Institute; 2014.
Broad JB, Gott M, Kim H, Boyd M, Chen H, Connolly MJ. Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health 2013; 58: 257-67.
Cohen J, Pivodic L, Miccinesi G, Onwuteaka-Philipsen BD, Naylor WA, Wilson DM et al. International study of the place of death of people with cancer: a population-level comparison of 14 countries across 4 continents using death certificate data. Br J Cancer 2015; 113: 1397-404.
Australia's Health. Australia's Health Series No. 15. Cat. No. AUS 199. Canberra; 2016.
Currow DC, Burns CM, Abernethy AP. Place of death for people with noncancer and cancer illness in South Australia: a population-based survey. J Palliat Care 2008; 24: 144-50.
Thomas C, Morris S, Clark D. Place of death: preferences among cancer patients and their carers. Soc Sci Med 2004; 58: 2431-44.
Wright AA, Keating NL, Balboni TA, Matulonis UA, Block SD, Prigerson HG. Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health. J Clin Oncol 2010; 28: 4457-64.
Hales S, Chiu A, Husain A, Braun M, Rydall A, Gagliese L et al. The quality of dying and death in cancer and its relationship to palliative care and place of death. J Pain Symptom Manage 2014; 48: 839-51.
Gomes B, Calanzani N, Koffman J, Higginson IJ. Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study. BMC Med 2015; 13: 235.
Grande GE, Farquhar MC, Barclay SIG, Todd CJ. Caregiver bereavement outcome: relationship with hospice at home, satisfaction with care, and home death. J Palliat Care 2004; 20: 69-77.
Aoun S, Bird S, Kristjanson LJ, Currow D. Reliability testing of the FAMCARE-2 scale: measuring family carer satisfaction with palliative care. Palliat Med 2010; 24: 674-81.
Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2013; 6: CD007760.
Luckett T, Phillips J, Agar M, Virdun C, Green A, Davidson PM. Elements of effective palliative care models: a rapid review. BMC Health Serv Res 2014; 14: 136.
Health Quality Ontario. Team-based models for end-of-life care: an evidence-based analysis. Ont Health Technol Assess Ser 2014; 14: 1-49.
Gomes B. Factors influencing death at home in terminally ill patients with cancer: systematic review. BMJ 2006; 332: 515-21.
Champion N, Medigovich K, Morrison PP. Exploring why some terminally ill people die in-hospital when home was their preferred hoice. Aust J Adv Nurs 2015; 33: 6-12.
Karlsen S, Addington-Hall J. How do cancer patients who die at home differ from those who die elsewhere? Palliat Med 1998; 12: 279-86.
Lam M, Lam HR, Agarwal A, Lam H, Chow R, Chow S et al. Barriers to home death for Canadian cancer patients: a literature review. J Pain Manag 2017; 10: 107-15.
Kristjanson LJ, Cousins K, White K, Andrews L, Lewin G, Tinnelly C et al. Evaluation of a night respite community palliative care service. Int J Palliat Nurs 2004; 10: 84-90.
Bell CL, Somogyi-Zalud E, Masaki KH. Methodological review: measured and reported congruence between preferred and actual place of death. Palliat Med 2009; 23: 482-90.
Gomes B, Calanzani N, Gysels M, Hall S, Higginson IJ. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care 2013; 12: 7.
Shepperd S, Gonçalves-Bradley DC, Straus SE, Wee B. Hospital at home: home-based end-of-life care. Cochrane Database Syst Rev 2016; 7: CD009231.
Gomes B, Calanzani N, Curiale V, McCrone PP, Higginson IJ, de Brito M. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Sao Paulo Med J 2016; 134: 93-4.