title: A randomized trial of the cost effectiveness of VA hospital-based home care for the terminally ill.
abstract: All admissions to a 1,100-bed Department of Veterans Affairs (VA) hospital were screened to identify 171 terminally ill patients with informal caregivers who were then randomly assigned to VA hospital-based team home care (HBHC, N = 85) or customary care (N = 86). Patient functioning, and patient and caregiver morale and satisfaction with care were measured at baseline, one month, and six months. Health services utilization was monitored over the six-month study period and converted to cost. Findings included no differences in patient survival, activities of daily living (ADL), cognitive functioning, or morale, but a significant increase in patient (p = .02) and caregiver (p = .005) satisfaction with care at one month. A substitution effect of HBHC was seen. Those in the experimental group used 5.9 fewer VA hospital days (p = .03), resulting in a $1,639 or 47 percent per capita saving in VA hospital costs (p = .02). As a result, total per capita health care costs, including HBHC, were $769 or 18 percent (n.s.) lower in the HBHC sample, indicating that expansion of VA HBHC to serve terminally ill veterans would increase satisfaction with care at no additional cost.
authors.affiliation: Department of Veterans Affairs, Health Services Research and Development (HSR&D) Field Program, Edward Hines, Jr. VA Hospital, Hines, IL.
authors.forename: S L
authors.initials: SL
authors.lastname: Hughes
authors.forename: J
authors.initials: J
authors.lastname: Cummings
authors.forename: F
authors.initials: F
authors.lastname: Weaver
authors.forename: L
authors.initials: L
authors.lastname: Manheim
authors.forename: B
authors.initials: B
authors.lastname: Braun
authors.forename: K
authors.initials: K
authors.lastname: Conrad
mesh_terms: D000203:Activities of Daily Living; D017028:Caregivers / Q000523:psychology; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003710:Demography; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D006746:Hospital Bed Capacity, 500 and over; D006787:Hospitals, Veterans / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois; D008609:Mental Status Schedule; D015999:Multivariate Analysis; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D013727:Terminal Care / Q000191:economics*; D016896:Treatment Outcome