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02-02-2012 | Legal medicine | Article

Home-based palliative care costs may be lower than alternatives


Free abstract

MedWire News: The cost of a home-based palliative shared-care project in rural Ontario in Canada falls within the parameters of US Medicare Hospice Benefits and is similar to funding assigned to long-term care homes, according to a cost analysis published in Palliative Medicine.

"Health care is a provincial responsibility in Canada. About 70% of health expenditures come from public sources. There is full coverage of all medically necessary services provided in hospitals or by physicians but Provinces and Territories vary in their coverage of other services delivered at home and for outpatient pharmaceuticals," explain Raisa Deber (University of Toronto, Ontario, Canada) and colleagues.

They investigated the Niagara West End-Of-Life Care Project, which was designed to provide home-based shared-care in a rural setting. The major features of the project included systematic identification of patients, needs assessment using Square Care domains, care coordinated by an expert palliative advanced practice nurse, symptom- and socially based support interventions, psychospiritual and bereavement care, and educational enhancement for primary care physicians and visiting nurses.

The project involved 95 patients, 83 of whom had a cancer diagnosis (mainly colorectal cancer, lung cancer, and breast cancer). The remaining 12 patients had advanced heart disease (n=4), COPD (n=3), and other conditions such as Alzheimer's disease (n=5).

Specialized nursing and home-making (which includes services such as house cleaning, laundry, shopping, preparing meals, etc.) were the resources most used; 87 patients received a total of 9555 hours of specialized nursing, and 68 patients received a total of 10,817 hours of home-making. Equipment rentals (67 patients), occupational therapy, and physical therapy (41 patients each) were also used frequently within the cohort.

The bereavement services were used by 56 patients and their families and 39 patients received extra physician consultations for pain and symptom management.

The total cost of all services included in the project was CA$ 1,625,658.07 (US$ 1,628,456.04; € 1,236,596.63) over a period of 15 months or CA$ 117.95 (US$ 118.15; € 89.72) per patient per day.

Cancer patients made up 87% of the study population and had a shorter average length of stay in the program (140 days) compared with noncancer patients (182 days). Their costs accounted for 82% of the total patient-related costs and therefore the costs per patient were lower than for the noncancer patients (CA$ 114.73 [US$114.92; € 87.24] and CA$ 135.07 [US$ 135.30; € 102.71] per day, respectively).

The researchers say that their overall calculated cost of CA$ 117.95 (US$ 118.15; € 89.72) per patient per day fall within the parameters of the US Medicare Hospice Benefits, which reimbursed at a rate of CA$ 125.71 (US$ 125.92; € 95.59) per day in 2007 and CA$ 142.55 (US$ 142.79; € 108.40 in 2010). The cost of the project was also lower than the funding assigned for long-term care homes by the Ontario Ministry of Health and Long-Term Care: CA$ 124.55 (US$ 124.76; € 94.71) in 2007 and CA$ 143.62 (US$ 143.86; € 109.21) in 2010.

"The analysis indicated that home-based service provision is less costly than alternate level of care or hospital-based alternatives," they conclude. "Studies like this one can be useful for future service/resource allocation planning and policy making."

By Chloe McIvor

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