Case conference primary-secondary care planning at end of life can reduce the cost of hospitalisations.
BACKGROUND
To plan integrated care at end of life for people with either heart failure or lung disease, we used a case conference between the patient's general practitioner (GP), specialist services and a palliative care consultant physician. This intervention significantly reduced hospitalisations and emergency department visits. This paper reports estimates of potential savings of reduced hospitalisation through end of life case conferences in a pilot study.


METHODS
We used Australian Refined Diagnosis Related Group codes to obtain data on hospitalisations and costs. The Australian health system is a federation: the national government is responsible for funding community based care, while state and territory governments fund public hospitals. There were 35 case conferences for patients with end stage heart failure or lung disease, who were patients of the public hospital system, involving 30 GPs in a regional health district.


RESULTS
The annualised total cost per patient was AUD$90,060 before CC and AUD$11,841 after CC. The mean per person cost saving was AUD$41,023 ($25,274 excluding one service utilisation outlier). For every 100 patients with end of life heart failure and lung disease each year, the case conferencing intervention would save AUD$4.1 million (AUD$2.5 million excluding one service utilisation outlier).


CONCLUSIONS
Multidisciplinary case conferences that promote integrated care among specialists and GPs resulted in substantial cost savings while providing care. Cost shifting between national and state or territory governments may impede implementation of this successful health service intervention. An integrated model such as ours is very relevant to initiatives to reform national health care.


BACKGROUND
Australian and New Zealand Controlled Trials Register ACTRN12613001377729 : Registered 16/12/2013.
School of Pharmacy, The University of Queensland, Woolloongabba, QLD, 4102, Australia.
Samantha
http://orcid.org/0000-0002-5226-5663
S
Hollingworth
School of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.
Jianzhen
J
Zhang
School of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.
Bharat Phani
BP
Vaikuntam
School of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.
Claire
C
Jackson
School of Medicine, The University of Queensland, Herston, QLD, 4006, Australia. g.mitchell@uq.edu.au.
Geoffrey
G
Mitchell
Cost savings; Delivery of health care; Hospitalisation; Integrated; Palliative care; Primary health care
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