Case conference primary-secondary care planning at end of life can reduce the cost of hospitalisations

Hollingworth, Samantha, Zhang, Jianzhen, Vaikuntam, Bharat Phani, Jackson, Claire and Mitchell, Geoffrey (2016) Case conference primary-secondary care planning at end of life can reduce the cost of hospitalisations. BMC Palliative Care, 15 1: 479-492. doi:10.1186/s12904-016-0157-9


Author Hollingworth, Samantha
Zhang, Jianzhen
Vaikuntam, Bharat Phani
Jackson, Claire
Mitchell, Geoffrey
Title Case conference primary-secondary care planning at end of life can reduce the cost of hospitalisations
Journal name BMC Palliative Care   Check publisher's open access policy
ISSN 1472-684X
Publication date 2016-09-23
Year available 2016
Sub-type Article (original research)
DOI 10.1186/s12904-016-0157-9
Open Access Status DOI
Volume 15
Issue 1
Start page 479
End page 492
Total pages 5
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Subject 2700 Medicine
Abstract Background: To plan integrated care at end of life for people with either heart failure or lung disease, we used a case conference between the patient's general practitioner (GP), specialist services and a palliative care consultant physician. This intervention significantly reduced hospitalisations and emergency department visits. This paper reports estimates of potential savings of reduced hospitalisation through end of life case conferences in a pilot study. Methods: We used Australian Refined Diagnosis Related Group codes to obtain data on hospitalisations and costs. The Australian health system is a federation: the national government is responsible for funding community based care, while state and territory governments fund public hospitals. There were 35 case conferences for patients with end stage heart failure or lung disease, who were patients of the public hospital system, involving 30 GPS in a regional health district. Results: The annualised total cost per patient was AUD$90,060 before CC and AUD$11,841 after CC. The mean per person cost saving was AUD$41,023 ($25,274 excluding one service utilisation outlier). For every 100 patients with end of life heart failure and lung disease each year, the case conferencing intervention would save AUD$4.1 million (AUD$2.5 million excluding one service utilisation outlier). Conclusions: Multidisciplinary case conferences that promote integrated care among specialists and GPS resulted in substantial cost savings while providing care. Cost shifting between national and state or territory governments may impede implementation of this successful health service intervention. An integrated model such as ours is very relevant to initiatives to reform national health care. Trial registration: Australian and New Zealand Controlled Trials Register ACTRN12613001377729: Registered 16/12/2013.
Formatted abstract
Background: To plan integrated care at end of life for people with either heart failure or lung disease, we used a case conference between the patient's general practitioner (GP), specialist services and a palliative care consultant physician. This intervention significantly reduced hospitalisations and emergency department visits. This paper reports estimates of potential savings of reduced hospitalisation through end of life case conferences in a pilot study.

Methods: We used Australian Refined Diagnosis Related Group codes to obtain data on hospitalisations and costs. The Australian health system is a federation: the national government is responsible for funding community based care, while state and territory governments fund public hospitals. There were 35 case conferences for patients with end stage heart failure or lung disease, who were patients of the public hospital system, involving 30 GPS in a regional health district.

Results: The annualised total cost per patient was AUD$90,060 before CC and AUD$11,841 after CC. The mean per person cost saving was AUD$41,023 ($25,274 excluding one service utilisation outlier). For every 100 patients with end of life heart failure and lung disease each year, the case conferencing intervention would save AUD$4.1 million (AUD$2.5 million excluding one service utilisation outlier).

Conclusions: Multidisciplinary case conferences that promote integrated care among specialists and GPS resulted in substantial cost savings while providing care. Cost shifting between national and state or territory governments may impede implementation of this successful health service intervention. An integrated model such as ours is very relevant to initiatives to reform national health care.

Trial registration: Australian and New Zealand Controlled Trials Register ACTRN12613001377729: Registered 16/12/2013.
Keyword Cost savings
Delivery of health care
Hospitalisation
Integrated
Palliative care
Primary health care
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID GNT1001157
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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