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Comparative Effectiveness of a Complex Care Program for High-Cost/High-Need Patients: a Retrospective Cohort Study
Douglas W Roblin1, Joel E Segel2, Richard J McCarthy3
1Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA. Douglas.W.Roblin@KP.Org.
Background:
High-cost/high-need (HCHN) adults and the healthcare systems that provide their care may benefit from a new patient-centered model of care involving a dedicated physician and nurse team who coordinate both clinical and social services for a small patient panel.
Objective:
Evaluate the impact of a Complex Care Program (CCP) on likelihood of patient survival and hospital admission in 180 days following empanelment to the CCP.
Design:
Retrospective cohort study using a quasi-experimental design with CCP patients propensity score matched to a concurrent control group of eligible but unempaneled patients.
Setting:
Kaiser Permanente Mid-Atlantic States (KPMAS) during 2017-2018.
Participants:
Nine hundred twenty-nine CCP patients empaneled January 2017-June 2018, 929 matched control patients for the same period.
Interventions:
The KPMAS CCP is a new program consisting of 8 teams each staffed by a physician and nurse who coordinate care across a continuum of specialty care, tertiary care, and community services for a panel of 200 patients with advanced clinical disease and recent hospitalizations.
Main Outcomes:
Time to death and time to first hospital admission in the 180 days following empanelment or eligibility.
Results:
Compared to matched control patients, CCP patients had prolonged time to death (hazard ratio [HR]: 0.577, 95% CI: 0.474, 0.704), and CCP decedents had longer survival (median days 69.5 vs. 53.0, p=0.03). CCP patients had similar time to hospital admission (HR: 1.081, 95% CI: 0.930, 1.258), with similar results when adjusting for competing risk of death (HR: 1.062, 95% CI: 0.914, 1.084).
Limitations:
Non-randomized intervention; single healthcare system; patient eligibility limited to specific conditions.
Conclusion:
The KPMAS CCP was associated with significantly reduced short-term mortality risk for eligible patients who volunteered to participate in this intervention.
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