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Patient-Centered Care Models Enhance End-of-Life Cancer Care

Patient-centered medical homes, patient navigators, and palliative care are effective forms of patient-centered end-of-life care.

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Source: Thinkstock

By Sara Heath

- Patient-centered medical home, patient navigation, and palliative care models can all improve cancer patient experience and reduce healthcare spending at the end-of-life, shows a new study published in Health Affairs.

End-of-life cancer care is often complicated, requiring a careful balance between reducing intensive treatments to support patient comfort and “giving up,” the research team said. Additionally, cancer patients often incur high healthcare costs at the end of life, typically due to high hospital and emergency department utilization.

According to the research team, three CMS Health Care Innovation Award winners have offered viable options for improving end-of-life cancer care, each of which reduced healthcare spending and healthcare utilization, and increased patient care.

The research team looked at the following care models between June 2012 and December 2015:

  • Community Oncology Medical Home (COME HOME): This model leveraged triage techniques to help patients access treatment in the appropriate setting. COME HOME also extended hours in all associated care settings, keeping patients from accessing the ED when they could otherwise visit their primary care provider. The model additionally supported patient activation and self-management.
  • Patient Care Connect Program (PCCP): This model used non-clinical patient navigators to help educate patients about different health resources and to empower patients to manage their own care. Navigators also worked as middlemen to connect patients to their providers, helping to explain health concepts to patients when appropriate. PCCP included a program to determine patient end-of-life goals and family wishes to smooth the transition to hospice care.
  • CARE Track: This palliative care model foremost assessed patient comfort levels and administered symptom management accordingly. The program also offered access to more intensive palliative care when necessary.

Researchers looked at cost savings, hospitalizations, and ED admission rates. Additionally, the team assessed chemotherapy use and hospice care utilization.

All three care models improved access to end-of-life care services and helped improve patient outcomes, the research team found. However, the way in which each model improved these factors differed depending upon the model’s structure.

COME HOME brought $3,346 in per patient cost savings in the last 90 days of a patient’s life. Because COME HOME offered extensive care access opportunities, patients could mitigate symptoms on their own or at less costly facilities rather than in the ED.

PCCP also created per patient cost savings of $5,824 and lowered healthcare utilization down to 40 hospitalizations per 1,000 patients. Additionally, PCCP resulted in fewer ED visits and higher hospice enrollment in the last 30 days of a patient’s life.

Driving hospice care utilization is a significant feat, the researchers noted.

“Though hospice is designed to facilitate patients’ end-of-life preferences, keeping patients at home or in a non-clinical environment while reducing pain and psychological stress and providing spiritual support, many patients are reluctant to choose hospice,” the researchers said, suggesting that this phenomenon is due to patient perceptions of “giving up.”

With effective pain management and satisfaction at the end of life, patients in the CARE Track had better qualitative results. Patients in CARE Track were also better able to communicate with their providers regarding their pain, allowing their quality of life to increase.

These findings can help inform other CMS initiatives to improve end-of-life cancer care, including the CMS Oncology Care Model, the researchers explained. The CMS Oncology Care Model includes elements of the COME HOME, PCCP, and CARE Track models.

“A comprehensive approach to cancer care could include features from all three interventions described in this study to improve end-of-life outcomes, appropriately adapted to the target population and setting,” the researchers concluded.

“As Medicare and other health care payers work to improve care and manage cost at the end of life, it will become increasingly important to implement innovative models of care for cancer patients.”

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