A systematic intervention to improve serious illness communication in primary care: Effect on expenses at the end of life.
Advance care planning
High-value healthcare
Palliative care
Quality improvement
Serious illness communication
Journal
Healthcare (Amsterdam, Netherlands)
ISSN: 2213-0772
Titre abrégé: Healthc (Amst)
Pays: Netherlands
ID NLM: 101622189
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
06
01
2020
revised:
26
04
2020
accepted:
29
04
2020
entrez:
20
6
2020
pubmed:
20
6
2020
medline:
15
12
2020
Statut:
ppublish
Résumé
At a population level, conversations between clinicians and seriously ill patients exploring patients' goals and values can drive high-value healthcare, improving patient outcomes and reducing spending. We examined the impact of a quality improvement intervention to drive better communication on total medical expenses in a high-risk care management program. We present our analysis of secondary expense outcomes from a prospective implementation trial of the Serious Illness Care Program, which includes clinician training, coaching, tools, and system interventions. We included patients who died between January 2014 and September 2016 who were selected for serious illness conversations, using the "Surprise Question," as part of implementation of the program in fourteen primary care clinics. We evaluated 124 patients and observed no differences in total medical expenses between intervention and comparison clinic patients. When comparing patients in intervention clinics who did and did not have conversations, we observed lower average monthly expenses over the last 6 ($6297 vs. $8,876, p = 0.0363) and 3 months ($7263 vs. $11,406, p = 0.0237) of life for patients who had conversations. Possible savings observed in this study are similar in magnitude to previous studies in advance care planning and specialty palliative care but occur earlier in the disease course and in the context of documented conversations and a comprehensive, interprofessional case management program. Programs designed to drive more, earlier, and better serious illness communication hold the potential to reduce costs. Prospectively designed trial, non-randomized sample, analysis of secondary outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
At a population level, conversations between clinicians and seriously ill patients exploring patients' goals and values can drive high-value healthcare, improving patient outcomes and reducing spending.
METHODS
METHODS
We examined the impact of a quality improvement intervention to drive better communication on total medical expenses in a high-risk care management program. We present our analysis of secondary expense outcomes from a prospective implementation trial of the Serious Illness Care Program, which includes clinician training, coaching, tools, and system interventions. We included patients who died between January 2014 and September 2016 who were selected for serious illness conversations, using the "Surprise Question," as part of implementation of the program in fourteen primary care clinics.
RESULTS
RESULTS
We evaluated 124 patients and observed no differences in total medical expenses between intervention and comparison clinic patients. When comparing patients in intervention clinics who did and did not have conversations, we observed lower average monthly expenses over the last 6 ($6297 vs. $8,876, p = 0.0363) and 3 months ($7263 vs. $11,406, p = 0.0237) of life for patients who had conversations.
CONCLUSIONS
CONCLUSIONS
Possible savings observed in this study are similar in magnitude to previous studies in advance care planning and specialty palliative care but occur earlier in the disease course and in the context of documented conversations and a comprehensive, interprofessional case management program.
IMPLICATIONS
CONCLUSIONS
Programs designed to drive more, earlier, and better serious illness communication hold the potential to reduce costs.
LEVEL OF EVIDENCE
METHODS
Prospectively designed trial, non-randomized sample, analysis of secondary outcomes.
Identifiants
pubmed: 32553522
pii: S2213-0764(20)30030-0
doi: 10.1016/j.hjdsi.2020.100431
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
100431Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest Dr. Block works as the Editor for Palliative Care for UpToDate. Drs. Lakin, Paladino, and Bernacki are supported by Sojourns Leadership Awards from the Cambia Health Foundation. None of the other authors report any conflicts of interest.