A Large-Scale Advanced Illness Intervention Informs Medicare's New Serious Illness Payment Model

Psychological interventions for emotional well-being in adults with advanced progressive life-limiting illness

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the benefits and harms of psychological interventions compared to treatment as usual, waiting list, active control, or another psychological intervention to improve emotional well-being in adults with an advanced progressive life-limiting illness.

Supportive Services at End of Life can Help Reduce Acute Care Services: Observations From the Medicare Care Choices Model

OBJECTIVES

This study identifies the mechanisms through which supportive and palliative care services at the end-of-life helped prevent unnecessary use of acute care services.

BACKGROUND

From 2016 to 2021, the Medicare Care Choices Model (MCCM) tested whether offering Medicare beneficiaries the option to receive supportive and palliative care services through hospice providers, concurrently with treatments for their terminal conditions, improved patients' quality of life and care and reduced Medicare expenditures. Previous MCCM evaluation results showed that the model achieved its goals, but did not examine in depth the causal mechanisms leading to these results.

METHODS

Mixed-methods evaluation based on descriptive analysis of MCCM encounter data and qualitative analysis of interviews with staff from high-performing MCCM hospices.

RESULTS

MCCM hospices provided 217 156 encounters to 7263 enrollees over 6 years. Enrollees received on average 30 encounters with hospice staff while enrolled in the model, representing about 10 encounters per month enrolled. Most encounters were delivered by clinically trained staff in the patient's home. Hospice staff identified five services critical for keeping patients from seeking acute care services: early and frequent needs assessments, direct observation of patients in their homes, immediate responses to patients' medical complaints, round-the-clock telephone access to nursing staff, and communication and coordination of care with primary care physicians and specialists.

CONCLUSIONS

Palliative care approaches that are high-touch, employ clinically trained staff who visit patients in their homes, routinely evaluate how to manage patient symptoms, and are available when needs arise can improve outcomes and decrease costs at the end of life.

Current definitions of advanced multimorbidity: a protocol for a scoping review

INTRODUCTION

People living with and dying from multimorbidity are increasing in number, and ensuring quality care for this population is one of the major challenges facing healthcare providers. People with multimorbidity often have a high burden of palliative and end-of-life care needs, though they do not always access specialist palliative care services. A key reason for this is that they are often not identified as being in the last stages of their life by current healthcare providers and systems.This scoping review aims to identify and present the available evidence on how people with multimorbidity are currently included in research, policy and clinical practice.

METHODS AND ANALYSIS

Scoping review methodology, based on Arksey and O'Malley's framework, will be undertaken and presented using the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews. Search terms have been generated using the key themes of 'multimorbidity', 'end of life' and 'palliative care'. Peer-reviewed research will be obtained through systematic searching of Medline, EMBASE, CINAHL, Scopus and PsycINFO. Grey literature will be searched in a systematic manner. Literature containing a definition for adults with multimorbidity in a terminal phase of their illness experience will be included. After screening studies for eligibility, included studies will be described in terms of setting and characteristics as well as using inductive content analysis to highlight the commonalities in definitions.

ETHICS AND DISSEMINATION

Ethical approval is not required for this scoping review. The findings of the scoping review will be used internally as part of SPB's PhD thesis at the University of St Andrews through the Multimorbidity Doctoral Training Programme for Health Professionals, which is supported by the Wellcome Trust (223499/Z/21/Z) and published in an open access, peer-reviewed journal for wider dissemination.

A Retrospective Evaluation of the Impacts of a Multidisciplinary Care Model for Managing Patients with Advanced Illness on Acute Care Utilization and Quality of Care at End of Life

Background: A home-based goal-concordant care model targeting patients with advanced illnesses may reduce acute care utilization and improve quality outcomes at end of life. Aim: Study aim was to determine impact of the Advanced Illness Management (AIM) program on end-of-life utilization and quality of care. Design: A retrospective observational study design using propensity score fine stratum weighting methodologies was applied to decedent patients identified for AIM enrollment/eligibility in 2018 to 2019. Setting/Participants: A total of 3859 decedents, 216 of whom were AIM enrollees, were identified from a metropolitan health system's electronic medical records (EMR) and met study eligibility criteria. Results: Compared with usual care, AIM enrollees spent more days away from acute care in the last 30, 90, and 180 days of life. Furthermore, AIM enrollees were less likely to expire in an acute care hospital. Conclusions: Enrollment in programs such as AIM should be considered for patients with advanced illnesses approaching end of life.

Nurse practitioners in home-based prepalliative care demonstrate an innovative, value-based approach to end-of-life care planning

BACKGROUND

Nurse practitioners (NPs) demonstrate value-based, home-based primary health care (HBPC) to home-bound patients with high disease burden at reduced cost.

PURPOSE

The research questions were as follows: (a) Does patient-centered, prepalliative care delivered by HBPC NPs decrease number of hospitalizations and emergency department (ED) visits and increase patient satisfaction? and (b) What are the criteria for patients to receive end-of-life (EOL) discussions by NPs?

METHODOLOGY

This was a quasi-experimental, retrospective two-group design with a convenience sample of 233 HBPC patients from an academic clinical partnership compared with 234 clinic patients matched on age and Charlson Comorbidity Index (CCI) score over 4 years. Measures included signed advanced directives (ADRs), medical orders of life-sustaining treatment (MOLST) forms, number and length of home visits, hospitalizations, and ED visits after diagnosis. Chi-square analyses and general linear models using a Poisson distribution were conducted.

RESULTS

Home-based primary health care patients had higher disease burden, statistically higher CCI scores, and signed ADR and MOLST agreements more often than clinic patients with significantly fewer hospitalizations and ED visits, and longer visits with providers.

CONCLUSIONS

Patients receiving HBPC for prepalliative, EOL illness benefit from more time to discuss the difficult factors surrounding access to care for those with life-threatening illnesses.

IMPLICATIONS

Recipients of prepalliative HBPC by NPs could require fewer provider visits, hospitalizations and ED visits, patient satisfaction, and a potential decrease in health care spending at EOL.