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The Impact of a Community-Based Serious Illness Care Program on Healthcare Utilization and Patient Care Experience
Timothy P Daaleman1,2, Natalie C Ernecoff2,3, Christine E Kistler1,2
1Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Objective:
Healthcare organizations are expanding community-based serious illness care programs to deliver care for homebound patients. Programs typically focus on home-based primary care or home-based palliative care, yet this population may require both services. We developed and evaluated a primary and palliative care program serving seriously ill older adults, called the Reaching Out to Enhance the Health of Adults in Their Communities and Homes (REACH) program. Our objective was to determine the impact of the REACH program on healthcare utilization and the patient care experience.
Design:
Case study using medical record review and telephone interviews.
Setting:
Home-based serious illness care program in central North Carolina.
Participants:
Patients enrolled in the REACH program from August 2014 to March 2016 (n = 159).
Intervention:
Home-based primary and palliative care delivered by an interdisciplinary team for seriously ill older adults.
Measurements:
Structured medical record review including demographics, health and functional status, and acute hospitalization and emergency department (ED) visits in the 12 months preceding and following initiation of the REACH program. A convenience sample of participants completed telephone interviews that measured the quality-of-care experience and quality of communication.
Results:
REACH patients had a 43% reduction in hospital visits and a 25% reduction in ED visits. Participants in telephone interviews reported a high-quality care experience and very good quality of communication with REACH providers.
Conclusion:
A care model that integrates home-based primary care and palliative care has the potential to reduce health service utilization and enhance the care experience for older patients with serious illness. J Am Geriatr Soc 67:825-830, 2019.
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