Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-20T18:57:46.218Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of home-based palliative care on health care costs and hospital use: A systematic review

Published online by Cambridge University Press:  09 December 2020

Valentina Gonzalez-Jaramillo Open the ORCID record for Valentina Gonzalez-Jaramillo [Opens in a new window] ,
Valérie Fuhrer ,
Nathalia Gonzalez-Jaramillo ,
Doris Kopp-Heim Open the ORCID record for Doris Kopp-Heim [Opens in a new window] ,
Steffen Eychmüller  and
Maud Maessen
Valentina Gonzalez-Jaramillo*
Affiliation:
Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012Bern, Switzerland Graduate School for Health Sciences, University of Bern, Bern, Switzerland
Valérie Fuhrer
Affiliation:
University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
Nathalia Gonzalez-Jaramillo
Affiliation:
Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012Bern, Switzerland Graduate School for Health Sciences, University of Bern, Bern, Switzerland
Doris Kopp-Heim
Affiliation:
Public Health & Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
Steffen Eychmüller
Affiliation:
University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
Maud Maessen
Affiliation:
Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012Bern, Switzerland University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
*
Author for correspondence: Valentina González-Jaramillo, Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To assess the effectiveness of home-based palliative care (HBPC) on reducing hospital visits and whether HBPC lowered health care cost.

Method

We searched six bibliographic databases (Embase (Ovid); Cochrane Central Register of Controlled Trials; Medline (Ovid); PubMed; Web of Science Core Collection; and, CINAHL) until February 2019 and performed a narrative synthesis of our findings.

Results

Of the 1,426 identified references, 21 articles based on 19 unique studies met our inclusion criteria, which involved 92,000 participants. In both oncological and non-oncological patients, HBPC consistently reduced the number of hospital visits and their length, as well as hospitalization costs and overall health care costs. Even though home-treated patients consumed more outpatient resources, a higher saving in the hospital costs counterbalanced this. The reduction in overall health care costs was most noticeable for study periods closer to death, with greater reductions in the last 2 months, last month, and last two weeks of life.

Significance of results

Stakeholders should recognize HBPC as an intervention that decreases patient care costs at end of life and therefore health care providers should assess the preferences of patients nearing the end-of-life to identify those who will benefit most from HBPC.

Keywords

Community careDomiciliary careHealth care costPalliative care
Type
Review Article
Information
Palliative & Supportive Care , Volume 19 , Issue 4 , August 2021 , pp. 474 - 487
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alonso-Babarro, A, Astray-Mochales, J, Dominguez-Berjon, F, et al. (2013) The association between in-patient death, utilization of hospital resources andavailability of palliative home care for cancer patients. Palliative Medicine 27(1), 68–75. doi:10.1177/0269216312442973.CrossRefGoogle ScholarPubMed
Bentur, N, Resnizky, S, Balicer, R, et al. (2014) Utilization and cost of services in the last 6 months of life of patients with cancer – with and without home hospice care. American Journal of Hospice & Palliative Medicine 31(7), 723–725. doi:10.1177/1049909113499604CrossRefGoogle ScholarPubMed
Blackhall, LJ, Read, P, Stukenborg, G, et al. (2016) CARE track for advanced cancer: Impact and timing of an outpatient palliative care clinic. Journal of Palliative Medicine 19(1), 57–63. doi:10.1089/jpm.2015.0272CrossRefGoogle ScholarPubMed
Brannstrom, M and Boman, K (2014) Effects of person-centred and integrated chronic heart failure and palliative home care. PREFER: A randomized controlled study. European Journal of Heart Failure 16(10), 1142–1151. doi:10.1002/ejhf.151CrossRefGoogle ScholarPubMed
Brereton, L, Clark, J, Ingleton, C, et al. (2017) What do we know about different models of providing palliative care? Findings from a systematic review of reviews. Palliative Medicine 31(9), 781–797. doi:10.1177/0269216317701890CrossRefGoogle ScholarPubMed
Brian Cassel, J, Kerr, KM, McClish, DK, et al. (2016) Effect of a home-based palliative care program on healthcare use and costs. Journal of the American Geriatrics Society 64(11), 2288–2295. doi:10.1111/jgs.14354CrossRefGoogle ScholarPubMed
Brick, A, Smith, S, Normand, C, et al. (2017) Costs of formal and informal care in the last year of life for patients in receipt of specialist palliative care. Palliative Medicine 31(4), 356–368. doi:10.1177/0269216316686277CrossRefGoogle ScholarPubMed
Chiang, JK and Kao, YH (2016) Impact of home hospice care on patients with advanced lung cancer: A longitudinal population-based study in Taiwan. Journal of Palliative Medicine 19(4), 380–386. doi:10.1089/jpm.2015.0278CrossRefGoogle ScholarPubMed
Chitnis, XA, Georghiou, T, Steventon, A, et al. (2013) Effect of a home-based end-of-life nursing service on hospital use at the end of life and place of death: A study using administrative data and matched controls. BMJ Supportive & Palliative Care 3(4), 422–430. doi:10.1136/bmjspcare-2012-000424CrossRefGoogle Scholar
de Miguel, C, Rubert de la Piedra, M, Garcia Perez, M, et al. (2018) Direct comparison of health costs in the last 2 months of life of oncological patients from death certificates in a peri-urban area, according to whether or not they had received care from a palliative home care team. [Comparacion directa de los costes sanitarios en los 2 ultimos meses de vida en pacientes oncologicos a partir de certificados de defuncion en un area periurbana segun reciban o no atencion en su domicilio por un equipo de cuidados paliativos]. Medicina Paliativa 25(4), 260–267. doi:10.1016/j.medipa.2017.05.003CrossRefGoogle Scholar
Ferroni, E, Avossa, F, Figoli, F, et al. (2016). Intensity of integrated primary and specialist home-based palliative care for chronic diseases in Northeast Italy and its impact on end-of-life hospital access. Journal of Palliative Medicine, 19(12), 1260–1266.CrossRefGoogle ScholarPubMed
Gade, G, Venohr, I, Conner, D, et al. (2008) Impact of an inpatient palliative care team: A randomized control trial. Journal of Palliative Medicine 11(2), 180–190. doi:10.1089/jpm.2007.0055CrossRefGoogle ScholarPubMed
Gomes, B, Calanzani, N, Curiale, V, et al. (2013) Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews 6, Cd007760. doi:10.1002/14651858.CD007760.pub2.Google Scholar
Guzman-Castillo, M, Ahmadi-Abhari, S, Bandosz, P, et al. (2017) Forecasted trends in disability and life expectancy in England and Wales up to 2025: A modelling study. Lancet Public Health 2(7), e307–e313. doi:10.1016/S2468-2667(17)30091-9CrossRefGoogle ScholarPubMed
He, W, Goodkind, D and Kowal, P (2016). An aging world: 2015. International Population Reports, P95/16-91.Google Scholar
Hopp, FP, Trzcinski, E, Roth, R, et al. (2015) Cost analysis of a novel interdisciplinary model for advanced illness management. American Journal of Hospice & Palliative Medicine 32(3), 350–356. doi:10.1177/1049909114523827CrossRefGoogle ScholarPubMed
Kerr, CW, Donohue, KA, Tangeman, JC, et al. (2014) Cost savings and enhanced hospice enrollment with a home-based palliative care program implemented as a hospice-private payer partnership. Journal of Palliative Medicine 17(12), 1328–1335. doi:10.1089/jpm.2014.0184CrossRefGoogle ScholarPubMed
Lukas, L, Foltz, C and Paxton, H (2013) Hospital outcomes for a home-based palliative medicine consulting service. Journal of Palliative Medicine 16(2), 179–184. doi:10.1089/jpm.2012.0414CrossRefGoogle ScholarPubMed
Lustbader, D, Mudra, M, Romano, C, et al. (2017) The impact of a home-based palliative care program in an accountable care organization. Journal of Palliative Medicine 20(1), 23–28.CrossRefGoogle Scholar
Maetens, A, Beernaert, K, De Schreye, R, et al. (2019) Impact of palliative home care support on the quality and costs of care at the end of life: A population-level matched cohort study. BMJ Open 9(1), e025180. doi:10.1136/bmjopen-2018-025180CrossRefGoogle Scholar
Maru, S, Byrnes, J, Carrington, MJ, et al. (2015) Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort – The WHICH? study (which heart failure Intervention is most cost-effective & consumer friendly in reducing hospital care). International Journal of Cardiology 201, 368–375. doi:10.1016/j.ijcard.2015.08.066CrossRefGoogle Scholar
May, P, Normand, C, Cassel, JB, et al. (2018) Economics of palliative care for hospitalized adults with serious illness: A meta-analysis. JAMA Internal Medicine 178(6), 820–829. doi:10.1001/jamainternmed.2018.0750CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, et al. (2009) Preferred reporting Items for systematic reviews and meta-analyses: The PRISMA statement. Plos Medicine 6(7), e1000097. doi: 10.1371/journal.pmed.1000097.CrossRefGoogle ScholarPubMed
Murphy, A, Siebert, K, Owens, D, et al. (2013) Health care utilization by patients whose care is managed by a primary palliative care clinic. Journal of Hospice & Palliative Nursing 15(7), 372–379. doi:10.1097/NJH.0b013e3182a02b9dCrossRefGoogle Scholar
Petrou, S and Gray, A (2011) Economic evaluation alongside randomised controlled trials: Design, conduct, analysis, and reporting. BMJ 342, d1548. doi:10.1136/bmj.d1548CrossRefGoogle ScholarPubMed
Pouliot, K, Weisse, CS, Pratt, DS, et al. (2017) First-year analysis of a new, home-based palliative care program offered jointly by a community hospital and local visiting nurse service. American Journal of Hospice & Palliative Medicine 34(2), 166–172. doi:10.1177/1049909115617139CrossRefGoogle ScholarPubMed
Riolfi, M, Buja, A, Zanardo, C, et al. (2014) Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: A retrospective cohort study. Palliative Medicine 28(5), 403–411. doi:10.1177/0269216313517283CrossRefGoogle ScholarPubMed
Sahlen, KG, Boman, K and Brannstrom, M (2016) A cost-effectiveness study of person-centered integrated heart failure and palliative home care: Based on a randomized controlled trial. Palliative Medicine 30(3), 296–302. doi:10.1177/0269216315618544CrossRefGoogle ScholarPubMed
Skov Benthien, K, Nordly, M, von Heymann-Horan, A, et al. (2018) Causes of hospital admissions in domus: A randomized controlled trial of specialized palliative cancer care at home. Journal of Pain & Symptom Management 55(3), 728–736. doi:10.1016/j.jpainsymman.2017.10.007CrossRefGoogle ScholarPubMed
Solutions, AH (2016). The final year: Visualizing end of life. Available at: https://www.arcadia.io/final-year-visualizing-end-life/Google Scholar
Sudat, SEK, Franco, A, Pressman, AR, et al. (2018) Impact of home-based, patient-centered support for people with advanced illness in an open health system: A retrospective claims analysis of health expenditures, utilization, and quality of care at end of life. Palliative Medicine 32(2), 485–492. doi:10.1177/0269216317711824CrossRefGoogle Scholar
Winkler, P, Koeser, L, Kondratova, L, et al. (2018) Cost-effectiveness of care for people with psychosis in the community and psychiatric hospitals in the Czech Republic: An economic analysis. Lancet Psychiatry 5(12), 1023–1031. doi:10.1016/S2215-0366(18)30388-2CrossRefGoogle ScholarPubMed
Wong, RCC, Tan, PT, Seow, YH, et al. (2013) Home-based advance care programme is effective in reducing hospitalisations of advanced heart failure patients: A clinical and healthcare cost study. Annals Academy of Medicine Singapore 42(9), 466–471.Google ScholarPubMed
World Health Organization (2018) Public spending on health: A closer look at global trend. Available at: https://apps.who.int/iris/bitstream/handle/10665/276728/WHO-HIS-HGF-HF-WorkingPaper-18.3-eng.pdf?ua=1.Google Scholar
World Health Organization (2019) WHO definition of palliative care. Available at: http://www.who.int/cancer/palliative/definition/en/ [2019 October 14].Google Scholar
Zhang, B, Nilsson, ME and Prigerson, HG (2012) Factors important to patients’ quality of life at the end of life. Archives of Internal Medicine 172(15), 1133–1142. doi:10.1001/archinternmed.2012.2364CrossRefGoogle Scholar
Supplementary material: File

Gonzalez-Jaramillo et al. supplementary material

Gonzalez-Jaramillo et al. supplementary material

Download Gonzalez-Jaramillo et al. supplementary material(File)
File 60.5 KB