title: Clinical impact of a home-based palliative care program: a hospice-private payer partnership.
abstract: BACKGROUND
  Outpatient programs have been traditionally offered in the U.S. under programs such as the Medicare Hospice Benefit. Recommendations now emphasize a blended model in which palliative care is offered concurrently with curative approaches at the onset of serious or life-limiting disease. The efficacy of nonhospice outpatient palliative care programs is not well understood.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the clinical impact of a home-based palliative care program, Home Connections, implemented as a partnership between a not-for-profit hospice and two private insurers.
  
  
  METHODS
  This was a prospective, observational, database study of 499 Home Connections participants enrolled between July 1, 2008, and May 31, 2013. Measured outcomes were advance directive completion, site of death, symptom severity over time, program satisfaction, and hospice referral and average length of stay.
  
  
  RESULTS
  Seventy-one percent of participants completed actionable advance directives after enrollment, and the site of death was home for 47% of those who died during or after participation in the program. Six of eight symptom domains (anxiety, appetite, dyspnea, well-being, depression, and nausea) showed improvement. Patients, caregivers, and physicians gave high program satisfaction scores (93%-96%). Home Connections participants who subsequently enrolled in hospice care had a longer average length of stay of 77.9 days compared with all other hospice referrals (average length of stay 56.5 days).
  
  
  CONCLUSIONS
  A home-based palliative care program was developed between two local commercial payers and a not-for-profit hospice. Not only did this program improve symptom management, advance directive completion, and satisfaction, but it also facilitated the transition of patients into hospice care, when appropriate.
authors.affiliation: The Center for Hospice & Palliative Care, Cheektowaga, New York, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Kerr
authors.affiliation: The Center for Hospice & Palliative Care, Cheektowaga, New York, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Tangeman
authors.affiliation: Rudra Research, Buffalo, New York, USA.
authors.forename: Carole B
authors.initials: CB
authors.lastname: Rudra
authors.affiliation: The Center for Hospice & Palliative Care, Cheektowaga, New York, USA. Electronic address: pgrant@palliativecare.org.
authors.forename: Pei C
authors.initials: PC
authors.lastname: Grant
authors.affiliation: The Center for Hospice & Palliative Care, Cheektowaga, New York, USA.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Luczkiewicz
authors.affiliation: Independent Health, Buffalo, New York, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Mylotte
authors.affiliation: The Center for Hospice & Palliative Care, Cheektowaga, New York, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Riemer
authors.affiliation: The Center for Hospice & Palliative Care, Cheektowaga, New York, USA.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Marien
authors.affiliation: Independent Health, Buffalo, New York, USA.
authors.forename: Amin M
authors.initials: AM
authors.lastname: Serehali
mesh_terms: D000328:Adult; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D016208:Databases, Factual; D005260:Female; D059033:For-Profit Insurance Plans / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006738:Hospices / Q000379:methods* / Q000592:standards*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D010820:Physicians / Q000523:psychology; D011446:Prospective Studies; D012017:Referral and Consultation; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Palliative care; end-of-life care; home-based palliative care; outpatient care