Hospice Day Research Articles

Pilot randomised controlled trial of focused narrative intervention for moderate to severe depression in palliative care patients: DISCERN trial

Background: Depression is poorly detected and sub-optimally managed in palliative care patients, and few trials of psychosocial interventions have been carried out in this group of patients. Aims: A pilot trial to determine the effect of a focused narrative intervention on depression in palliative care patients when used in addition to usual care. Design: Patients scoring 10 or higher on Patient Health Questionnaire-9 randomised to focused narrative intervention in addition to usual care or usual care only and followed up at 2, 4 and 6 weeks. A reduction of five points on Patient Health Questionnaire-9 was regarded as clinically significant response to treatment. Setting/participants: Palliative care patients aged over 18 recruited from hospice day care services – exclusion criteria included an estimated prognosis of 6 weeks or less, cognitive impairment and unable to understand written or spoken English. Results: Out of 57 participating patients (71% female), with mean age 65.1 years (range 36–88 years), 33 patients were randomised to the intervention and 24 to usual care only. Mean Patient Health Questionnaire-9 score at baseline was 16.4. Patients receiving intervention had greater reduction in Patient Health Questionnaire-9 score at 6-week follow-up (p = 0.04). Median survival was 157 days for intervention and 102 days for control group patients (p = 0.07). Conclusion: This pilot trial suggests a focused narrative intervention in palliative care patients with moderate to severe depression can reduce depression scores more than usual care alone. Patients receiving intervention appeared to have longer survival. These results support the need for a fully powered trial.

Hospice Visit Intensity by Physicians and Nurse Practitioners on the General Inpatient Level of Care (TH371C)

•Describe the rate of physician or nurse practitioner services during GIP service.•Describe episode characteristics associated with the rate of physician or nurse practitioner services during GIP service. The Medicare Hospice Benefit’s General Inpatient (GIP) level of care is intended to provide for pain and symptom management in an inpatient facility that could not be managed in the patient’s home. Examine how beneficiaries utilize physician and nurse practitioner services while receiving GIP care. Retrospective cohort analysis of Medicare hospice beneficiaries utilizing GIP during Federal Fiscal Year 2014 (FY2014). Using 100% Medicare hospice and Part B claims from FY2014 we examined physician and nurse practitioner service visit intensity during GIP. We found that among the 1.5 million GIP days serviced in FY2014, the majority of days (52.4%) were not associated with any recorded physician or nurse practitioner services. Rates of the absence of these services were particularly high among hospice GIP days provided in (Acute) Inpatient Facilities (69.1% of days missing physician/nurse practitioner services), Long-Term Care Hospitals (84.3% missing services), and Skilled Nursing Facilities (85.3% missing services). Moreover, one in five hospice episodes that have at least three days of sequential GIP care did not have any physician or nurse practitioner services recorded from either the hospice or Part B claims; this was true for more than half of such episodes beginning in long-term care hospitals or skilled nursing facilities. We found that over two-thirds of all GIP days are serviced in hospice inpatient units and that cancer was the most common primary hospice diagnosis at admission among GIP days. GIP is an important component of the hospice benefit and these findings underscore a recent Office of Inspector General report finding variation in the utilization of GIP.

What Is the Cost of Disease Progression Among Patients with Indolent or Aggressive Non-Hodgkin Lymphoma (NHL)?

Background: The natural histories of aggressive and indolent NHL vary in terms of the timing and pattern of disease progression. However, little is known about the impact of progression of disease (PD) on costs, and in particular how this differs between aggressive and indolent subtypes of NHL. This study examined patterns of care and outcomes for patients with aggressive and indolent NHL, and the impact of PD on health care costs.Methods: To identify cases of NHL, this retrospective studyused medical and pharmacy claims from a large national US health plan to identify commercially insured and Medicare Advantage (MA) patients age ≥18 years from 1/2007 - 8/2014 with ≥2 medical claims for NHL based on ICD-9-CM diagnosis codes. Patients were divided into cohorts of aggressive (AGG) NHL and indolent (IND) and based on diagnosis codes. Patients were required to have ≥1 claim for systemic anti-cancer therapy, with the index date being defined as the first observed claim for such therapy. Continuous enrollment in the health plan for 6 months prior to (baseline period), and ≥6 months after, the index date (variable follow-up period) was required; patients with <6 months of follow-up due to death were included. An algorithm to identify line of therapy (LOT) periods was implemented. PD was defined as: start of a second LOT, receipt of hospice care (based on procedure or revenue codes) or death (based on Social Security Administration death data). Health care costs were calculated over 6-month periods of follow-up (6, 12, 18, 24 months), with costs calculated for pharmacy, inpatient hospital, ambulatory, and other sites of service.Results: A total of 1,197 AGG and 2,454 IND patients met study criteria. Progression was experienced by 40.6% of AGG and 49.4% of IND patients respectively during the entire study period; 6-month progression was 18.9% (AGG) and 18.5% (IND). Compared to patients without PD during the study period, patients who progressed had higher average costs over each time period: in the first 6-months, costs were $138,957 PD vs. $108,607 for non-PD among AGG, and $114,644 PD vs. $80,873 for non-PD among IND (Figure, Table). Similarly, total costs for PD were higher than non-PD over 12, 18, and 24 months (Figure). Costs by site of service were higher for PD patients compared to non-PD patients among both the AGG and IND groups, particularly for inpatients costs; the table shows costs by site of service for the first 6 months, and results were similar over 12, 18, and 24 months. A higher proportion of AGG patients died compared with IND patients. Approximately one third of patients who died used hospice services among AGG and IND, and of these, 90.1% of AGG and 91.3% of IND used 3 or more days of hospice care.Conclusion: Among both aggressive and indolent NHL populations, costs were higher for patients with progressive versus without progressive disease, and increased over longer follow-up time. Patients with aggressive NHL had higher costs compared with patients with indolent NHL for both progressive and non-progressive disease. This study is the first to quantify systematically the cost of progression in NHL, both indolent and aggressive, and can inform efforts to improve value-based care, taking into account costs not just of therapy, but of subsequent progression. [Display omitted] [Display omitted] DisclosuresEngel-Nitz:Optum: Employment, Other: UnitedHealth Group stock. Dacosta Byfield:UnitedHealth Group: Equity Ownership; Optum: Employment. Bancroft:Optum: Employment, Other: UnitedHealth Group stock. Amy:Optum: Employment, Other: UnitedHealth Group stock. Reyes:Genentech: Employment; Roche: Equity Ownership.

Multiple Complex Chronic Conditions and Pediatric Hospice Utilization among California Medicaid Beneficiaries, 2007-2010.

Over 42,000 children die each year in the United States, including many with multiple complex chronic conditions (MCCCs), but little is known about whether the presence of MCCCs influences families to utilize pediatric hospice care. The study objective was to examine the relationship between MCCCs and pediatric hospice utilization among Medicaid beneficiaries. A retrospective, longitudinal cohort design was conducted with 2007-2010 California Medicaid data to examine the relationship between MCCCs (i.e., two or more MCCCs) and pediatric hospice utilization (i.e., hospice enrollment, hospice length of stay). Multivariate logistic regression with year fixed effects examined the effect of MCCCs on hospice enrollment, and negative binomial model with year fixed effects explored the relationship between MCCCs and hospice length of stay. More than 10% of children enrolled in hospice care with an average length of stay of approximately three days. In the study sample, 48.6% of the children had MCCCs. MCCCs were not significantly related to hospice enrollment. However, children with MCCCs (incidence rate ratios = 4.25, p < 0.01) were associated with an increase in the number of days in hospice care. This study demonstrated that children with MCCCs have limited hospice care utilization at end of life. Future research is needed to explore barriers to hospice care for children with MCCCs.

Patients' perceptions of palliative care quality in hospice inpatient care, hospice day care, palliative units in nursing homes, and home care: a cross-sectional study.

BackgroundPatients’ perceptions of care quality within and across settings are important for the further development of palliative care. The aim was to investigate patients’ perceptions of palliative care quality within settings, including perceptions of care received and their subjective importance, and contrast palliative care quality across settings.MethodA cross-sectional study including 191 patients in late palliative phase (73 % response rate) admitted to hospice inpatient care, hospice day care, palliative units in nursing homes, and home care was conducted, using the Quality from the Patients’ Perspective instrument-palliative care (QPP-PC). QPP-PC comprises four dimensions and 12 factors; “medical–technical competence” (MT) (2 factors), “physical–technical conditions” (PT) (one factor), “identity–orientation approach” (ID) (4 factors), “sociocultural atmosphere” (SC) (5 factors), and three single items (S); medical care, personal hygiene and atmosphere. Data were analysed using paired-samples t-test and analysis of covariance while controlling for differences in patient characteristics.ResultsPatients’ perceptions of care received within settings showed high scores for the factors and single items “honesty” (ID) and “atmosphere” (S) in all settings and low scores for “exhaustion” (MT) in three out of four settings. Patients’ perceptions of importance scored high for “medical care” (S), “honesty” (ID), “respect and empathy” (ID) and “atmosphere” (S) in all settings. No aspects of care scored low in all settings. Importance scored higher than perceptions of care received, in particular for receiving information. Patients’ perceptions of care across settings differed, with highest scores in hospice inpatient care for the dimensions; ID, SC, and “medical care” (S), the SC and “atmosphere” (S) for hospice day care, and “medical care” (S) for palliative units in nursing homes. There were no differences in subjective importance across settings.ConclusionStrengths of services related to identity–orientation approach and a pleasant and safe atmosphere. Key areas for improvement related to receiving information. Perceptions of subjective importance did not differ across settings, but perceptions of care received scored higher in more care areas for hospice inpatient care, than in other settings. Further studies are needed to support these findings, to investigate why perceptions of care differ across settings and to highlight what can be learned from settings receiving high scores.

Hospice Use, Hospitalization, and Medicare Spending at the End of Life.

Prior studies associate hospice use with reduced hospitalization and spending at the end of life based on all Medicare hospice beneficiaries. In this study, we examine the impact of different lengths of hospice care and nursing home residency on hospital use and spending prior to death across 5 disease groups. We compared inpatient hospital days and Medicare spending during the last 6 months of life using hospice versus propensity matched non-hospice beneficiaries who died in 2010, were enrolled in fee for service Medicare throughout the last 2 years of life, and were in at least 1 of 5 disease groups. Comparisons were based on length of hospice use and whether the decedent was in a nursing home during the seventh month prior to death. We regressed a categorical measure of hospice days on outcomes, controlling for observed patient characteristics. Hospice use over 2 weeks was associated with decreased hospital days (1-5 days overall, with greater decreases for longer hospice use) for all beneficiaries; spending was $900-$5,000 less for hospice use of 31-90 days for most beneficiaries not in nursing homes, except beneficiaries with Alzheimer's. Overall spending decreased with hospice use for beneficiaries in nursing homes with lung cancer only, with a $3,500 reduction. The Medicare hospice benefit is associated with reduced hospital care at the end of life and reduced Medicare expenditures for most enrollees. Policies that encourage timely initiation of hospice and discourage extremely short stays could increase these successes while maintaining program goals.

Impact of pancreatic cancer treatment on hospice utilization.

52 Background: There is an increasing incidence of pancreatic cancer over time, a cancer with a 5-year survival rate of only 7.2%.For patients with poor prognosis cancers, hospice is an important resource, but it is often not utilized or underutilized. Factors influencing hospice use are difficult to determine. We sought to evaluate the impact of pancreatic cancer treatment on hospice utilization. Methods: National Surveillance Epidemiology and End Results (SEER)-Medicare data was utilized to identify all incident cases of pancreatic cancer patients who died (2005-09, with follow up to 2011). Patients were stratified by primary treatment strategy: surgery, chemotherapy, or no treatment. Hospice utilization in the last 6 months of life, including average and median days enrolled in hospice and average time from diagnosis to hospice was evaluated. Results: 17,031 patients were identified, with 68.5% enrolling in hospice in the last 6 months of life. Patients undergoing surgery were less likely to enroll in hospice compared to patients not undergoing surgery (58.7% vs 69.4%, p &lt; 0.0001). Interestingly, surgical patients spent on average 31.2 days in hospice (median 15.0 days) which was comparable to the non-surgical cohort (average 32.7 days, median 16.0 days; p = 0.32). Patients who received any chemotherapy spent an average of 29.2 days in hospice (median 15 days) compared to those who did not undergo chemotherapy, who spent an average of 34.5 days in hospice (median 16 days); p &lt; 0.0001. While total hospice enrollment was equivalent between the chemotherapy and no chemotherapy cohorts (67.5% vs 69.1%), the time spent in hospice was significantly different (p &lt; 0.0001). Patients not receiving any cancer-directed treatment enrolled in hospice at an average of 78.6 days (median 32 days) from diagnosis. Conclusions: Pancreatic cancer patients undergoing surgery enrolled in hospice to a much lesser extent than patients who did not have surgery. Patients not receiving cancer-directed treatment spend a relatively short time in hospice. Overall, hospice appears to be underutilized, and the majority of patients with this poor prognosis cancer are not realizing the full benefits of hospice.

Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South.

155 Background: Healthcare utilization and costs escalate near diagnosis and in the final months of life. There is a national trend toward aggressive care at end of life (EOL). We examined patterns in utilization and cost across the trajectory of care and during the last two weeks of life during implementation of a lay navigation intervention. Methods: Claims data were obtained for Medicare beneficiaries ≥ 65 years old with cancer in the UAB Health System Cancer Community Network (UAB CCN). For 10 quarters from January 2012 -June 2014, we examined healthcare utilization for the population at large, navigated patients, and decedents. All analyses included ER visits, hospitalizations, and ICU admissions and use of chemotherapy in the last 2 weeks of life, and hospice utilization (admission or less than 3 days of hospice) in the quarter of death for decedents. Descriptive analyses and linear regression were used to test trends over time; general linear models evaluated changes in health care utilization and cost. Results: Across the population reduction of 13.4% to 11% for hospitalization (18% decrease, p &lt; 0.01), 8.0% to 7.1% for ER visits (12% decrease, p &lt; 0.01), 2.9% to 2.5% for ICU admissions (14% decrease, p = 0.04) and an increase of 3.9% to 4.3% for hospice (9.2% increase p = 0.37) were found. Among 5,861 decedents, in the last 2 weeks of life, there were decreases in ICU admissions (14.6% decrease, p = 0.11), from 39.2% to 32.0%, ER visits (18.4% decrease, p = 0.03), and chemotherapy, from 4.7% to 3.5% (25.5% decrease, p = 0.11).Over the 10 quarters, hospice enrollment increased from 70.7% to 77.4% (9.48% increase; p = 0.06), and the proportion of patients on hospice for less than 3 days changed from 7.8% to 7.5% (3.85% decrease, p = 0.30). Costs decreased about $158 per quarter per beneficiary. A significant pre-post decrease of $952 per beneficiary (p &lt; 0.01) led to an estimated reduction in Medicare costs of $18,406,920 for the 19,335 beneficiaries in the UAB CCN for the five quarters post-implementation. Conclusions: We observed decreased healthcare utilization and cost and trends toward decreased aggressive care at EOL in the UAB CCN. Further work is needed to determine the impact of navigation on utilization trends.

Characteristics of Hospice Programs With Problematic Live Discharges

ContextLittle is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. ObjectivesTo characterize hospices with high rates of problematic patterns of live discharges. MethodsThree hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located. ResultsIn 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4%). About one in three (33.8%) for-profit providers exhibited one or more of these discharge patterns compared with 9.0% of not-for-profit providers. ConclusionProblematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain.

“But the Family Is Asking for a Blood Transfusion”: Managing the Hematologic Malignancy Patient in Hospice (SA503)

Objectives Identify certification/recertification issues in hematologic malignancies. Recognize when blood-product transfusion is consistent with hospice goals and how it can be achieved in a cost-efficient manner. Discuss how to enhance communication about continuing or discontinuing transfusion therapies. Discuss the identification and support of psychosocial and spiritual needs and concerns in the hematologic patient. Hospice physicians are increasingly receiving referrals from hematologists. Hematologic malignancies are a challenging group of diseases because they are a heterogeneous group of cancers comprising more than 50 subtypes. Disease trajectories can be erratic. Patients with indolent diseases, such as primary myelofibrosis or chronic lymphocytic leukemia, often stabilize in hospice care and are challenging to recertify, while patients with acute leukemia are frequently admitted later in their clinical course and often live only hours to days in hospice. Patients with acute leukemias have often received frequent transfusions of blood products to control symptoms and prevent bleeding. Hospice physicians are often confronted with a patient who is deemed likely to die within 6 months yet requires costly, labor-intensive transfusions to benefit poorly categorized symptoms or ones requiring true interventions. Sorting out when to have the conversation about withholding blood products and recognizing when they are appropriate can be challenging for the hospice team. There are instances in which transfusions of blood products can be consistent with hospice goals of care. However, cost issues can make transfusions prohibitive without special relationships with transfusion providers. Decisions about transfusions require both knowledge of goals of care and specific knowledge about prognosis and costeffective ways to handle blood product support. This session will, through the use of didactics, case presentations, and audience participation, enable attendees to walk away with (a) improved understanding of the prognosis of hematologic malignancies and certification/recertification issues associated with them, (b) enhanced understanding of blood product support needs for hematologic malignancies and how to provide them in a cost-efficient manner, (c) improved communication techniques when discussing discontinuation of transfusions, and (d) enhanced identification and support of psychosocial and spiritual distress needs and concerns in the hematology patient.

Preference for a single or shared room in a UK inpatient hospice: patient, family and staff perspectives

ObjectiveThis study investigated the preferences of patients, family and staff for single or shared rooms in a UK hospice.MethodSemistructured interviews were conducted with patients, informal carers and staff at a...

An evaluation of the St Christopher's Hospice rehabilitation gym circuits classes: Patient uptake, outcomes, and feedback

BackgroundEvidence suggests exercise may benefit patients with advanced progressive illness and some hospice day services now provide dedicated gym space. However, supporting data for such a service development are limited. We describe patient referrals, interventions, feedback, and potential impact of a nine-session, outpatient, hospice-based, circuit exercise programme.MethodsConsecutive referrals to physiotherapy over a 6-month period commencing March 2013 were followed prospectively. Physical function (short physical performance battery (SPPB), grip strength), fatigue (Functional Assessment of Chronic Illness Therapy), psychological well-being (General Health Questionnaire), and patient satisfaction (FACIT-PS) were assessed pre- and post-programme.ResultsOf 212 referrals, 61 (29%) with a range of cancer and non-cancer diagnoses (median [inter-quartile range] survival 67 [50–137] days) were considered appropriate for the circuits of whom 54 (89%) started. There were no statistical differences between those completing and not-completing with regards to age, diagnosis, social status, or survival. In completers (n = 28), 4-m gait speed (mean Δ [95% confidence intervals] 0.23 [0.03, 0.44] m/seconds), five sit-to-stand time (mean Δ −5.44 [−10.43, −0.46] seconds) and overall SPPB score changed statistically, while grip strength did not (mean Δ 0.65 [−1.39, 2.96] kg). Psychological well-being, quality of life, and fatigue remained unchanged. Patients felt the physiotherapists gave clear explanations, understood their needs, and would recommend the service to others.ConclusionA hospice-based programme is one way to offer exercise to a range of patients with advanced progressive illness. Despite excellent feedback, only half of patients completed the nine-session programme in full and evidence of benefit was limited. Future work should explore the broader benefits of participation and whether delivering programmes or elements of them in shorter time frames is more beneficial.

INTEGRATED PALLIATIVE CARE/ADVANCED RESPIRATORY DISEASE (ARD) CLINICS – A MULTI-CENTRE PILOT PROJECT

BackgroundThe symptom burden of ARD is similar to that of cancer, however patients with COPD are less likely to access Specialist Palliative Care (SPC) Services, and less likely to die...

Should we involve terminally ill patients in teaching medical students? A systematic review of patient's views

ObjectiveTo review available published research that has explored how terminally ill patients feel about being involved in undergraduate medical teaching.MethodsA systematic review using narrative synthesis. Qualitative or quantitative publications were...

Retrospective Assessment of Healthcare Utilization and Palliative Care Involvement for Patients with End-Stage HIV (S749)

1.Understand the high utilization of health care services by HIV-infected patients at the end of life.2.Understand that end stage HIV patients have limited palliative care contact and consequently a high number of in-hospital deaths, low hospice referral rates and limited days in hospice at the end of life. HIV has become a complex chronic disease and in 2009 the prevalence of persons living with HIV/AIDS in the United States was 1.1 million. Despite advances in treatment, mortality remains higher than the general population and evidence show there is a large symptom burden associated with HIV infection that would benefit from early palliative care involvement. In this study, we assess utilization and quality of end of life care for HIV patients. Claims for our HIV patients were matched to Social Security Death Index data to determine date of death. 92 adult HIV patients died between January 2009 and July 2011 and had at least 1 contact with our health system in their last six months of life. All inpatient and outpatient claims data generated in the last six months of life at our hospital were analyzed. Overall, 30% of patients died in the hospital. Compared to other chronic diseases such as CHF and cancer, our HIV patients had more frequent and more intense hospital use in the last 30 days of life: 38% of patients were admitted to the hospital, 12% had more than 1 emergency room visit and 26% had an intensive care unit admission. Length of stay was 9.7 days per admit in the last 6 months of life. Despite this, of all 92 patients, only 20% of patients had palliative care involvement and only 15% were discharged with hospice. In addition, 24.3% of patients had less than three days enrolled in hospice before death. Palliative care was involved a median of 5.5 days prior to death. Palliative care services are grossly underutilized for our HIV-infected population despite the large symptom burden these patients suffer and high mortality rate.

Association Between Palliative Case Management and Utilization of Inpatient, Intensive Care Unit, Emergency Department, and Hospice in Medicaid Beneficiaries

Association between palliative case management (PCM) and the utilization of major health services during the last 30 days of life in Medicaid patients with cancer was assessed using retrospective cohort analysis. There were 132 PCM enrollees in the intervention group and 54 non-PCM enrollees in the comparison group. The intervention group had lower inpatient admission rate than that of the comparison group (56.8% vs 74.1%), lower ICU admission rate (12.9% vs 24.1%), longer mean hospice days (45.8 vs 31.1 days), and lower percentage of persons with death in hospital (24.2% vs 35.9%). No statistically significant differences were found in mean intensive care unit days (8.7 vs 9.7 days), treat-and-release emergency department visit rate (22.0% vs 16.7%), or hospice election rate (65.9% vs 70.4%). Palliative case management may reduce hospitalization and increase hospice use in patients nearing death.

Learning from challenges in the recruitment of patients with advanced cancer from hospice day care

BackgroundThe background literature suggests that recruiting patients with advanced cancer from hospice day care to participate in a research study may be challenging.AimThis paper describes such challenges and considers whether those faced by researchers in this study reflect those recorded in the literature.MethodSix hundred and twenty-six patients with advanced cancer from hospice day care units in the north-west region of England were recruited as part of a multi-centre mixed methods study to determine the prevalence, aetiology, and natural history of depression and demoralization.ResultsA number of challenges were reported (i) data collection sometimes presented researchers with ethical dilemmas, although the ability to respond appeared to be influenced by disciplinary background and training, (ii) emotional impact of the research may force researchers to face a variety of emotional responses, and (iii) dilemmas relating to the setting and maintenance of role boundaries included determining the level of emotional connection required to establish relationships of trust between researchers and participants, and imbalances in power and status.DiscussionMany of the challenges faced by researchers to recruit patients with advanced cancer from hospice day care to participate in this research study were similar to those described in the literature.ConclusionMost researchers reported that the overall experience was positive, although a number of moral and ethical dilemmas required ongoing reflection and continuing support and supervision to resolve. It is hoped that other researchers engaging in similar forms of research in the future can learn from the challenges that have been identified.

How effective is telephonic case management of patients with cancer?

254 Background: Case management offers the opportunity to improve quality of cancer care but the financial impact is largely unknown. Optum’s Cancer Support Program (CSP) provides patients and their caregivers with telephonic case management services which are focused on reducing emergency department visits and hospitalizations, and helping patients comply with treatments and more effectively manage symptoms related to their disease or to its treatment. This study evaluates the effectiveness of CSP primarily from financial perspectives. Methods: The study used a case control approach to compare participants and non-participants of the Optum CSP program. The propensity score method was applied to adjust for baseline differences between the two groups. The study population consisted of cancer patients (N=8,833) enrolled in commercial health plans through self-insured employers. The patients were referred to CSP between July 2009 and June 2011. Analyses were conducted for survivors and decedents separately to account for mortality bias. Outcomes of cost and hospice days were estimated with generalized linear models. Results: For program participants who were under active treatment and survived at least 6 months after referral, cancer-related medical cost per patient per month during the six months of follow up was reduced by 9.8% (95% confidence interval [3.7%, 15.6%], p-value 0.002), and almost 60% of the cost savings were from inpatient admissions. The decedent’s cost during the last 3 months of the life was reduced by 19.9% (95% confidence interval [2.8%, 34.1%], p-value 0.025), and more than 80% of the cost savings were from inpatient admissions. The average hospice days of all deceased CSP participants increased by 42.3%, (95% confidence interval [13.9%, 77.8%], p-value 0.002). Conclusions: We conclude the Optum CSP program is effective in reducing medical cost among both cancer survivors under active treatment and those who did not survive, while promoting hospice utilization during end-of-life.

P44 The introduction of a patient education programme into a hospice day service

At a time when hospice care is being scrutinised by commissioners this small study evaluates the implementation of an education programme in a Day Hospice and the impact this had...

P145 Life stories: Rebuilding self esteem through sharing and recording biographical stories

IntroductionIn 2012 we were approached by a local storyteller. We experimented with a simple programme, offering patients the opportunity to tell their stories on an informal basis and produced a...