Moving Upstream: A Review of the Evidence of the Impact of Outpatient Palliative Care

Rabow, Michael W.; Kvale, Elizabeth; Barbour, Lisa; Cassel, J. Brian; Cohen, Susan E.; Jackson, Vicki A.; Luhrs, Carol; Nguyen, Vincent; Rinaldi, Simone; Stevens, Donna; Spragens, Lynn; Weissman, David E.

doi:10.1089/jpm.2013.0153

Cited by 170 publications

(113 citation statements)

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“…Characteristics of included reviews 15 16 ; meta synthesis 26 and narrative reviews 7,17,18,19,20,21,22,23,24,25,27,30 . 14 Our approach to reporting on the models across settings is pragmatic due to the lack of detailed 15 description of the models in the included publications.…”

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confidence: 99%

What do we know about different models of providing palliative care? Findings from a systematic review of reviews

et al. 2017

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Article:Brereton, L., Clark, J., Ingleton, C. orcid.org/0000-0001-5489-1089 et al. (4 more authors) (2017) What do we know about different models of providing palliative care? Findings from a systematic review of reviews. Palliative Medicine. ISSN 0269-2163 https://doi.org/10.1177/0269216317701890 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. Review of models of palliative care1 What is already known about the topic? 1  Globally, as demand for palliative care is increasing amongst those with life-limiting illnesses, 2 there has been a rapid growth in specialist and generalist palliative care service provision with a 3 range of different of models of palliative care service provision being developed and 4 implemented internationally. 5 The published evidence has been synthesised in a number of reviews which have attempted to 6 identify the effectiveness and cost effectiveness of different models of palliative care. 7 There is no comprehensive overview of the current evidence base to support decision-making 8 based on the advantages and disadvantages of different models of palliative care or to identify 9 any gaps in the evidence base where more primary research is needed. 10What this paper adds? 11 The outcomes measured vary considerably, making meta-analysis impossible. None-the-less, 12 the available evidence indicates that irrespective of setting or patient characteristics, models of 13 palliative care appear to show benefits for patients and their carers, with no evidence for 14 negative effects. Some models of palliative care may reduce total healthcare costs.

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What do we know about different models of providing palliative care? Findings from a systematic review of reviews

et al. 2017

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“…The very high percentages of respondents saying they had difficulty getting good data or information needed for developing and evaluating community-based palliative care (CBPC) may help to explain the relatively slow adoption of PC in those settings. 3 It is difficult to make the clinical or financial case for expanding from inpatient to ambulatory PC without good data on results achieved to date, or the number and characteristics of patients who might benefit from earlier, proactive PC engagement.…”

Section: Discussionmentioning

confidence: 99%

Data Challenges for Planning and Evaluating Palliative Care Programs

Brian

KerrKathleen

BroomeLewis

2016

Journal of Palliative Medicine

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ResultsFifty-four responses were received for a 25% response rate. Almost all (n = 53, 98.1%) respondents indicated they had an inpatient consultation service. Almost two-thirds (n = 35, 64.8%) said they had some form of community-based PC service including one or more of the following: regularly scheduled ambulatory clinic (n = 27, 50.0%); home-based services (n = 23, 42.6%); and/or telephonic services (n = 14, 25.9%). Table 1 shows the percentage of respondents (excluding those who said they had never asked for each kind of 36.7% Impact of PC on clinical outcomes (n = 50) 57.1% Length of stay, costs, and revenue for PC-relevant hospitalized patients including those who didn't use PC (n = 50) 69.4%Patterns of hospital use in final months of life for patients with progressive, life-limiting diseases (e.g., percent admitted in final 30 days of life) (n = 45) 70.5%Cost reduction following inpatient PC consultation or use of PCU unit (n = 48) 76.6% Number of patients with progressive, life-limiting diseases who might benefit from ambulatory/community-based PC (n = 45) 84.1%Impact of existing ambulatory/community-based PC program on financial and operational metrics such as hospital admissions, costs, revenues (n = 33) 90.6%Estimates of operational and financial impacts if relevant patients had access to ambulatory/community-based PC (n = 38) 94.6%

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“…115 Extending palliative care integration in the community and expanding primary palliative care core competencies across the workforce through communication and symptom management skills training are vital steps to reliably meet the quality of life and support needs of patients and caregivers where they live. [116][117][118] Advocating for enactment of legislation that expands palliative care awareness, access, training, and research is an important action that stakeholders can take to help increase palliative care availability and accessibility for patients with CVD and their caregivers. 3.…”

Section: May 8 2018mentioning

confidence: 99%

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

Dunbar¹,

Khavjou²,

Bakas³

et al. 2018

Circulation

202

102

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INTRODUCTION:In a recent report, the American Heart Association estimated that medical costs and productivity losses of cardiovascular disease (CVD) are expected to grow from $555 billion in 2015 to $1.1 trillion in 2035. Although the burden is significant, the estimate does not include the costs of family, informal, or unpaid caregiving provided to patients with CVD. In this analysis, we estimated projections of costs of informal caregiving attributable to CVD for 2015 to 2035. METHODS:We used data from the 2014 Health and Retirement Survey to estimate hours of informal caregiving for individuals with CVD by age/sex/race using a zero-inflated binomial model and controlling for sociodemographic factors and health conditions. Costs of informal caregiving were estimated separately for hypertension, coronary heart disease, heart failure, stroke, and other heart disease. We analyzed data from a nationally representative sample of 16 731 noninstitutionalized adults ≥54 years of age. The value of caregiving hours was monetized by the use of home health aide workers' wages. The per-person costs were multiplied by census population counts to estimate nation-level costs and to be consistent with other American Heart Association analyses of burden of CVD, and the costs were projected from 2015 through 2035, assuming that within each age/sex/racial group, CVD prevalence and caregiving hours remain constant. RESULTS:The costs of informal caregiving for patients with CVD were estimated to be $61 billion in 2015 and are projected to increase to $128 billion in 2035. Costs of informal caregiving of patients with stroke constitute more than half of the total costs of CVD informal caregiving ($31 billion in 2015 and $66 billion in 2035). By age, costs are the highest among those 65 to 79 years of age in 2015 but are expected to be surpassed by costs among those ≥80 years of age by 2035. Costs of informal caregiving for patients with CVD represent an additional 11% of medical and productivity costs attributable to CVD. CONCLUSIONS:The burden of informal caregiving for patients with CVD is significant; accounting for these costs increases total CVD costs to $616 billion in 2015 and $1.2 trillion in 2035. These estimates have important research and policy implications, and they may be used to guide policy development to reduce the burden of CVD on patients and their caregivers.

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Moving Upstream: A Review of the Evidence of the Impact of Outpatient Palliative Care

Abstract: The available evidence supports the ongoing expansion of innovative outpatient palliative care service models throughout the care continuum to all patients with serious illness.

Cited by 170 publications

References 58 publications

What do we know about different models of providing palliative care? Findings from a systematic review of reviews

What do we know about different models of providing palliative care? Findings from a systematic review of reviews

Data Challenges for Planning and Evaluating Palliative Care Programs

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

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