Search

Association between palliative case management (PCM) and the utilization of major health services during the last 30 days of life in Medicaid patients with cancer was assessed using retrospective cohort analysis. There were 132 PCM enrollees in the intervention group and 54 non-PCM enrollees in the comparison group. The intervention group had lower inpatient admission rate than that of the comparison group (56.8% vs 74.1%), lower ICU admission rate (12.9% vs 24.1%), longer mean hospice days (45.8 vs 31.1 days), and lower percentage of persons with death in hospital (24.2% vs 35.9%). No statistically significant differences were found in mean intensive care unit days (8.7 vs 9.7 days), treat-and-release emergency department visit rate (22.0% vs 16.7%), or hospice election rate (65.9% vs 70.4%). Palliative case management may reduce hospitalization and increase hospice use in patients nearing death.

This study evaluated a cancer case management pilot program focusing on palliative care, the Omega Life Program (OLP), by assessing whether the program was associated with reduced hospital utilization.A retrospective observational study of patients with cancer who enrolled in the OLP (intervention) compared to those who chose not to enroll (comparison) from January 1, 2005 to February 28, 2007. Patients were included in the primary analyses if they died by the end of the study period and were enrolled in the program at least 1 week before death. Patients were followed from the time of referral until death. Outcomes included whether or not the patients had any admissions during this period and, for patients with at least one admission, the total number of inpatient hospital admissions, inpatient days, and hospital costs.Approximately 75% of eligible patients enrolled in the OLP; 60% were older than 50 and 60% were female. Of included patients in the intervention group (n = 69), 59% had no admissions compared to 15% of patients in the comparison group (n = 20). However, among patients who had at least one admission, the mean number of hospital admissions, inpatient days, and hospitals costs were not significantly different between the groups.In this pilot study, patients in the OLP had significantly reduced odds of having any hospital admissions compared to those in usual care. This type of program may improve outcomes for patients, but further research is needed to evaluate outcomes using larger samples and more rigorous study designs.