--- title: "Impact of palliative care program-cost, use, QOL. | Sutter Health" description: "Advanced Illness Management program has a positive impact on inpatient utilization, cost of care, hospice enrollment, and site of death." url: "https://www.sutterhealth.org/research/publications/impact-of-palliative-care-program-cost-use-qol-1055312725" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Impact of palliative care program-cost, use, QOL. # Impact of home-based, patient-centered support for people with advanced illness in an open health system: a retrospective claims analysis of health expenditures, utilization, and quality of care at end of life. Sudat SEK, Franco A, Pressman AR, Rosenfeld K, Gornet E, & Stewart W. _Palliat Med. 2018 Feb;32(2):485-492. doi: 10.1177/0269216317711824. Epub 2017 Jun 7._ 2018-02-01 ## Abstract BACKGROUND: Home-based care coordination and support programs for people with advanced illness work alongside usual care to promote personal care goals, which usually include a preference for home-based end-of-life care. More research is needed to confirm the efficacy of these programs, especially when disseminated on a large scale. Advanced Illness Management is one such program, implemented within a large open health system in northern California, USA. AIM: To evaluate the impact of Advanced Illness Management on end-of-life resource utilization, cost of care, and care quality, as indicators of program success in supporting patient care goals. DESIGN: A retrospective-matched observational study analyzing medical claims in the final 3 months of life. SETTING/PARTICIPANTS: Medicare fee-for-service 2010-2014 decedents in northern California, USA.RESULTS: Final month total expenditures for Advanced Illness Management enrollees ( N = 1352) were reduced by US$4824 (US$3379, US$6268) and inpatient payments by US$6127 (US$4874, US$7682). Enrollees also experienced 150 fewer hospitalizations/1000 (101, 198) and 1361 fewer hospital days/1000 (998, 1725). The percentage of hospice enrollees increased by 17.9 percentage points (14.7, 21.0), hospital deaths decreased by 8.2 percentage points (5.5, 10.8), and intensive care unit deaths decreased by 7.1 percentage points (5.2, 8.9). End-of-life chemotherapy use and non-inpatient expenditures in months 2 and 3 prior to death did not differ significantly from the control group. CONCLUSION: Advanced Illness Management has a positive impact on inpatient utilization, cost of care, hospice enrollment, and site of death. This suggests that home-based support programs for people with advanced illness can be successful on a large scale in supporting personal end-of-life care choices. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/28590150) ![Sylvia Sudat, Ph.D.](https://dyn.mktgcdn.com/p/2AHRaDJwevdbwzC2ecrwY3nYIxbiqxd9NbpxBlI8Kpk/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Sylvia Sudat, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/sylvia-sudat-phd-1049681027) ## Research topics - [Aging and Longevity](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Aging+and+Longevity%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Advance care planning in older adults with multiple chronic conditions undergoing high-risk surgery.](https://www.sutterhealth.org/research/publications/advance-care-plans-with-seniors-and-high-risk-surgery-1055312419) Tang VL, Dillon EC, Yang Y, Tai-Seale M, Boscardin J, Kata A, Sudore RL. JAMA Surg. doi: 10.1001/jamasurg.2018.4647. \[Epub ahead of print\] 2018 Dec 05 - Publication ### [Community-based palliative care and advance care planning documentation: evidence from a multispecialty group.](https://www.sutterhealth.org/research/publications/palliative-care-advance-care-planning-documentation-1055312325) Tai-Seale M, Yang Y, Dillon E, Tapper S, Lai S, Yu P, Allore H, Ritchie C. J Am Geriatr Soc. 2018 Feb;66(2):327-332. doi: 10.1111/jgs.15145. Epub 2017 Oct 24. 2017 Oct 24 - Publication ### [Predicting need for advanced illness or palliative care in a primary care population using electronic health record data.](https://www.sutterhealth.org/research/publications/predict-need-for-palliative-care-in-primary-care-with-ehrs-1055312675) Jung K, Sudat SEK, Kwon N, Stewart WF, Shan NH. J Biomed Inform. 92:103115. 2019 Apr 01 - Publication ### [Comparative usability study of a newly created patient-centered tool and Medicare.gov plan finder to help Medicare beneficiaries choose prescription drug plans.](https://www.sutterhealth.org/research/publications/pt-centered-drug-plan-finder-vs-medicaregov-1055312687) Stults CD, Fattahi S, Meehan A, Bundorf MK, Chan AS, Pun T, Tai-Seale M. J Patient Exp. 6(1):81-86. doi: 10.1177/2374373518778343. Epub 2018 Jun 6. 2019 Mar 01 - Publication ### [Patient experiences in selecting a Medicare Part D prescription drug plan.](https://www.sutterhealth.org/research/publications/pt-experiences-selecting-medicare-part-d-rx-drug-plan-1055312300) Stults CD, Baskin AS, Bundorf MK, Tai-Seale M. J Patient Experience. https://doi.org/10.1177/2374373517739413 2017 Nov 21 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/impact-of-palliative-care-program-cost-use-qol-1055312725#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Impact of palliative care program-cost, use, QOL."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/impact-of-palliative-care-program-cost-use-qol-1055312725#medicalscholarlyarticle","name":"Impact of home-based, patient-centered support for people with advanced illness in an open health system: a retrospective claims analysis of health expenditures, utilization, and quality of care at end of life.","headline":"Impact of palliative care program-cost, use, QOL.","abstract":"BACKGROUND: Home-based care coordination and support programs for people with advanced illness work alongside usual care to promote personal care goals, which usually include a preference for home-based end-of-life care. More research is needed to confirm the efficacy of these programs, especially when disseminated on a large scale. Advanced Illness Management is one such program, implemented within a large open health system in northern California, USA. AIM: To evaluate the impact of Advanced Illness Management on end-of-life resource utilization, cost of care, and care quality, as indicators of program success in supporting patient care goals. DESIGN: A retrospective-matched observational study analyzing medical claims in the final 3 months of life. SETTING/PARTICIPANTS: Medicare fee-for-service 2010-2014 decedents in northern California, USA.RESULTS: Final month total expenditures for Advanced Illness Management enrollees ( N = 1352) were reduced by US$4824 (US$3379, US$6268) and inpatient payments by US$6127 (US$4874, US$7682). Enrollees also experienced 150 fewer hospitalizations/1000 (101, 198) and 1361 fewer hospital days/1000 (998, 1725). The percentage of hospice enrollees increased by 17.9 percentage points (14.7, 21.0), hospital deaths decreased by 8.2 percentage points (5.5, 10.8), and intensive care unit deaths decreased by 7.1 percentage points (5.2, 8.9). End-of-life chemotherapy use and non-inpatient expenditures in months 2 and 3 prior to death did not differ significantly from the control group. CONCLUSION: Advanced Illness Management has a positive impact on inpatient utilization, cost of care, hospice enrollment, and site of death. 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