An Australian casemix classification for palliative care: technical development and results

Area of Science:

• Health Services Research
• Palliative Care Medicine
• Health Economics

Background:

• Palliative care requires a classification system applicable across various settings (hospital, hospice, home-based).
• Existing classifications may not adequately capture the complexities of palliative care needs and costs.
• Understanding cost drivers is crucial for resource allocation and service delivery optimization in palliative care.

Purpose of the Study:

• To develop and validate a casemix classification for palliative care.
• To create a system applicable to inpatient, hospice, and home-based palliative care episodes.
• To identify key predictors of palliative care costs across different settings.

Main Methods:

• Utilized data from 3866 palliative care patients across 58 services in Australia and New Zealand.
• Collected detailed clinical and service utilization profiles, measuring staff time and resources daily.
• Applied regression tree analysis to group care episodes based on similar costs and clinical characteristics.

Main Results:

• Developed the Australian National Sub-acute and Non-acute Patient (AN-SNAP) Classification Version 1.
• The inpatient branch has 11 classes, explaining 20.98% of cost variance.
• The ambulatory branch has 22 classes, explaining 17.14% of cost variance.

Conclusions:

• Phase of care (illness stage), functional status, and age are key predictors of palliative care costs.
• The AN-SNAP classification provides clinical meaning but has moderate statistical performance.
• The classification structure allows for future refinement as palliative care models evolve.