Models of care for serious illness: What is the evidence?

Abstract

168 Background: Individuals with cancer and other serious illness may benefit from specialized models of care, including palliative care. However, limited evidence exists to guide real-world implementation of such programs. We reviewed evidence supporting models of care for serious illness as part of a larger effort to develop an implementation framework for serious illness care programs. Methods: We conducted a systematic review, focusing on existing reviews and meta-analyses across a broad range of serious illness population definitions and programs. The quality of evidence was graded and results were synthesized with respect to five outcomes categories (patient and caregiver experience; care and support processes; health outcomes; health service use and costs; and operations), program components associated with success, and implementation considerations. Results: Collectively, 28 reviews were identified, reporting 743 studies, 426 of which were randomized controlled trials. The strongest and most consistent evidence was for reduced health service use and costs (e.g., reduced hospitalization and emergency department use) and for improved patient and caregiver experiences. Few reviews reported on operational outcomes. Program components most frequently reported as associated with success included targeted selection of high-risk patients; face-to-face contact; and transition management. Common recommendations for implementation (reported in 10 of 28 reviews) included attention to relationship building, inclusion of technology-enabled decision support and continuous quality improvement. Conclusions: Compelling evidence exists for improved outcomes across a range of serious illness care models and populations with palliative care needs. Policy attention to payment structures that support feasibility and sustainability of these care models is warranted. Future research might address gaps in the literature, including implementation-related factors, operational outcomes and the relative contribution of individual components associated with program success.