Access to community-based palliative care increases the likelihood that seriously ill patients will die at home in accordance with their wishes, a new study has found. These services also generate health care cost savings through reductions in high-acuity care.
Researchers from Northern Illinois University (NIU) and Seattle University performed the first systematic literature review to date to gauge the effectiveness of community-based palliative care in achieving desired outcomes. The study authors examined research contained in four electronic academic databases for papers published through August 2021. The study appeared in the journal Social Science & Medicine.
“[The study findings] are especially relevant now because there’s the push by legislators for Medicare to cover these services,” study author M. Courtney Hughes, associate professor in the School of Health Studies at NIU, told Hospice News. “Put them together with the improvements in quality-of-life-related outcomes, there’s a strong case for implementing community based palliative care.”
Hospices provide nearly 50% of home- and community-based palliative care in the United States, according to a 2019 study by the Center to Advance Palliative Care (CAPC). Many of these providers have reported a rise in demand for this care during the COVID-19 pandemic.
In July of last year a bipartisan group of Senators from the Comprehensive Care Caucus introduced the Expanding Access to Palliative Care Act, which would create a dedicated community-based palliative care benefit within Medicare. To date the bill has not moved forward.
In September 2021, 10 members of the U.S. House of Representatives Ways & Means Committee wrote to U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure to call for a demonstration to test such a benefit. The agency’s Center for Medicare & Medicaid Innovation (CMMI) has the authority to develop and test new payment models without seeking congressional approval for each demonstration.
The establishment of a dedicated palliative care payment model has been a longstanding goal of many in the hospice community.
The study, which was international in scope, also revealed unanswered questions in the palliative care space that require more research to unravel, according to the authors. This includes findings that some programs were less successful than others in achieving positive clinical or financial outcomes. The authors recommend additional investigations into the characteristics of successful programs.
Researchers also cited a lack of available literature on palliative care in low-income and lower-middle-income countries, as well as the impact of those services on some vulnerable populations, globally. The study found variations in results among patients with certain diagnoses and between older versus younger patients that require further inquiry.
In the United States, a key issue was the racial and socioeconomic disparities that persist in the nation’s health care system.
“One other suggestion we would have for future research in the United States is looking into disparities of care that are often reported here in terms of end-of-life care,” said co-author Erin Vernon, associate professor of economics at Seattle University. “The little bit of research that’s done in this area is highly promising and could help alleviate some of these issues. More needs to be done to confirm those findings.”
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