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.
The Johns Hopkins Medical Institutions, Johns Hopkins Health Care, Department of Care Management Administration, Baltimore, MD, USA linwang@jhmi.edu.
Lin
L
Wang
The Johns Hopkins Medical Institutions, Johns Hopkins Health Care, Department of Care Management Administration, Baltimore, MD, USA.
Leslie
L
Piet
The Johns Hopkins Medical Institutions, Johns Hopkins Health Care, Department of Care Management Administration, Baltimore, MD, USA.
Catherine M
CM
Kenworthy
The Johns Hopkins University, Bloomberg School of Public Health, Department of Health Policy & Management, Baltimore, MD, USA.
Sydney M
SM
Dy
D019090:Case Management / Q000706:statistics & numerical data*; D003422:Critical Care / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D017051:Hospice Care / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013727:Terminal Care / Q000191:economics / Q000706:statistics & numerical data; D014481:United States
case management; end of life; health care utilization; health services utilization; medicaid; palliative care