Abstract
Objectives
In the United States, people with serious illness often experience gaps and discontinuity
in care. Gaps are frequently exacerbated by limited mobility, need for social support,
and challenges managing multiple comorbidities. The Advanced Illness Care (AIC) Program
provides nurse practitioner–led, home-based care for people with serious or complex
chronic illnesses that specifically targets palliative care needs and coordinates
with patients’ primary care and specialty health care providers. We sought to investigate
the effect of the AIC Program on hospital encounters [hospitalizations and emergency
department (ED) visits], hospice conversion, and mortality.
Design
Retrospective nearest-neighbor matching.
Setting and Participants
Patients in AIC who had ≥1 inpatient stay within the 60 days prior to AIC enrollment
to fee-for-service Medicare controls at 9 hospitals within one health system.
Methods
We matched on demographic characteristics and comorbidities, with exact matches for
diagnosis-related group and home health enrollment. Outcomes were hospital encounters
(30- and 90-day ED visits and hospitalizations), hospice conversion, and 30- and 90-day
mortality.
Results
We included 110 patients enrolled in the AIC Program matched to 371 controls. AIC
enrollees were mean age 77.0, 40.9% male, and 79.1% white. Compared with controls,
AIC enrollees had a higher likelihood of ED visits at 30 [15.1 percentage points,
confidence interval (CI) 4.9, 25.3; P = .004] and 90 days (27.8 percentage points, CI 16.0, 39.6; P < .001); decreased likelihood of hospitalization at 30 days (11.4 percentage points,
CI –17.7, −5.0; P < .001); and a higher likelihood of converting to hospice (22.4 percentage points,
CI 11.4, 33.3; P < .001).
Conclusions
The AIC Program provides care and coordination that the home-based serious illness
population may not otherwise receive.
Implications
By identifying and addressing care needs and gaps in care early, patients may avoid
unnecessary hospitalizations and receive timely hospice services as they approach
the end of life.
Keywords
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Article info
Publication history
Published online: June 08, 2021
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
