Table 1.
Potential Population Management Interventions and Outcomes
| Outcomes | |||||
|---|---|---|---|---|---|
| Reference | Population | Intervention components | Quality of patient care | Health care utilization | Cost |
| aTemel et al. 2013 Electronic prompt to improve outpatient code status documentation for patients with advanced lung cancer | Incurable lung cancer (NSCLC or small/large-cell neuro-endocrine) Within 8 weeks of receiving first dose of IV chemotherapy Had ECOG performance from 0–2 |
E-mail reminders sent 1) At the first outpatient visit after the patient had enrolled 2) On the day of an outpatient appointment immediately after the start of each new line of chemotherapy until a code status was documented in the EHR |
Greater number of documented code status modules completed† | No health care utilization analysis conducted | No cost analysis conducted |
| bLoo et al. 2011 Electronic medical record reminders and panel management to improve primary care of elderly patients | Patients 65 years of age or older Faculty PCP at site ≥1 visit to practice in 18 months prior to study |
1) Compared: Standard EMR EMR reminders for advance directives, aspirin chemoprevention, Beers medication alerts, fall screening, osteoporosis screening, and vaccinations EMR reminders+assistance from panel manager (assessed whether care had already been received, and if not, reminded the patient of recommended care) |
EMR reminder: -Increased influenza vaccination‡ -Increased pneumococcal vaccination* EMR reminder+panel manager: -Increased rate of designated health care proxy‡ -Increased rate of bone density screening† -Increased influenza vaccination‡ -Increased pneumococcal vaccination† |
No health care utilization analysis conducted | No cost analysis conducted |
| cGustafson et al. 2013 An eHealth system supporting palliative care for patients with non–small cell lung cancer | Multisite in East, Midwest, and Southwest U.S. NSCLC Stage IIIA-IV and primary caregiver willing to participate; life expectancy ≥4 months |
CHESS website 1) Provides lung cancer, care giving, and bereavement information 2) Serves as channel to communicate with peers, experts, clinicians 3) Provides feedback to users based on their input and established algorithms/pathways 4) Provides tools to improve caregiving experience Clinicians alerted if patients report poor health status and receive patient questions |
Caregivers reported lower physical symptom distress in patients† Improved patient survival† |
No health care utilization analysis conducted | No cost analysis conducted |
| dBakitas et al. 2009 Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer | Dartmouth Norris Cotton Cancer Center – Lebanon, NH Patients with a life-limiting cancer diagnosis with prognosis of approximately 1 year |
Nurse conducted telephone curriculum of 4 structured education sessions with patients Monthly telephone-based follow-up with distress assessment Monthly group shared medical appointments |
Higher quality of life* Less symptom intensity Less depressed mood* |
No difference in number of days in hospital or ICU No difference in number of ED visits |
No cost analysis conducted |
| eAbernethy et al. 2012 Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness | South Australia Any patient referred to palliative care service who was experiencing pain in last 3 months and expected to live >48 hours with a life-limiting illness |
Compared: 1) Case conferences 2) GP education outreach 3) Patient/caregiver education 4) Standard care |
Case conference was associated with maintaining performance status* Case conference* and patient/caregiver education* associated with maintenance of performance status if the patient's initial performance status represented ≥70% decline from baseline. Reduction in total symptoms burden with patient/caregiver education* |
Significant reduction in number of hospitalizations with case conference† | No cost analysis conducted |
| fBrumley et al. 2007 Increased satisfaction with care and lower costs: Results of a randomized trial of in-home palliative care | Kaiser Permanente in Hawaii and Colorado Patients with CHF, COPD, or cancer and prognosis of ≤1 year plus ≥1 hospital or ED visits in last year |
Home-based interdisciplinary care Palliative care team coordinates care across all settings Patient and family education 24/7 telephone RN service |
Improved satisfaction at 30 days* and at 90 days* More likely to die at home‡ Note: There was a strong trend toward shorter survival for those in the palliative care group (196 days vs. 242 days) |
Fewer ED visits† Fewer hospitalizations‡ (Linear regression showed intervention reduced hospital days‡ and ED visits*) |
Reduction in total costs of care‡ Reduction in daily costs* Mean reduction of $7,552 (33%) for intervention group |
| gStuart et al. 2013 Advance care model honors dignity, integrated health system for seriously ill people and loved ones | Sutter Health Patients with advance disease who meet any following: -≥1 chronic dx -Questionable benefit from further aggressive treatment -Functional/nutritional decline in last 30 days -Hospice eligible but not ready for hospice -Frequent ED visits and hospitalizations in last 6 months |
1) Care managers assist in advance directives, personal health record tool, complete POLST 2) Care liaisons and social workers assist with discharge planning and transitional care 3) Home-based care when needed 4) Telephone calls to assess patient, trigger alerts to clinicians if problems 5) Transition to hospice if desired and appropriate |
High satisfaction with care | Increased use of hospice Fewer hospitalizations Fewer ICU days Reduced LOS for hospitalizations Reduction in physician office visits |
Cost savings of $760 per enrollee per month |
*
Statistically significant p<0.05
†Statistically significant p<0.01
‡Statistically significant p<0.001
CHESS, Center for Health Enhancement System Studies; COPD, chronic obstructive pulmonary disease; ECOG, Eastern Cooperative Oncology Group; EMR, electronic medical record; LOS, length of stay; NSCLC, nonsmall cell lung cancer; PCP, primary care provider; POLST, physicians orders for life sustaining treatment.