A recent research project that combined palliative care with dementia care management reduced emergency department visits and hospitalizations by half among its patient population.
Dubbed the IN-PEACE program, or the Indiana Palliative Excellence in Alzheimer Care Efforts, the research sought to measure the potential impact of combining palliative care with an enhanced dementia care model.
That model aligns to a large degree with that used within the Guiding an Improved Dementia Experience (GUIDE) payment demonstration from the Center for Medicare and Medicaid Innovation, according to study author and research scientist Dr. Greg Sachs with the Indiana University Center for Aging Research at Regenstrief Institute.
The IN-PEACE project began before the GUIDE model was announced, but both models contain similar elements.
“[The U.S. Centers for Medicare & Medicaid Services (CMS)] is doing a demonstration project where they’re doing something that they’re calling the GUIDE model that incorporates many of these kinds of services, not just for patients, but also for caregivers to try and provide support for both of them in the home,” Sachs told Palliative Care News. “That’s really a model that’s grown up over the last 20 years that still has been difficult to implement into practice. And so the CMS GUIDE model is actually providing a funding source.”
Sachs is also chief of the Division of General Internal Medicine and Geriatrics at the Indiana University School of Medicine. He is also the co-director of Research in Palliative and End-of-Life Communication and Training (RESPECT) Center, a professor of medicine and neurology, and holder of an endowed chair in health services research at the Indiana University School of Medicine.
African American patients and those with lower socioeconomic status benefited the most from IN-PEACE, according to the research, which was published in the Journal of the American Medical Association. More than 40% of the study population were African American patients or caregivers.
“Black or African American individuals were one group that benefited most. Another group that benefited most was people with low-income households,” Sachs said. “So we were providing this sort of state of the art care to people who may not have had access to it.”
IN-PEACE participants were older, frailer and experienced more severe Alzheimer’s disease or other dementias than many individuals who have participated in previously developed dementia management programs, according to the Regenstrief Institute.
Patient and family participants in the intervention arm of the IN-PEACE study received monthly check-ins via telephone for up to two years from a nurse or social worker to help caregivers manage issues such as patients’ neuropsychiatric symptoms, caregiver distress and palliative care concerns such as advance care planning and referral to hospice. The program placed an emphasis on education and communication skills.
This regular contact enabled clinicians to address problems to help prevent escalation to an emergency room visit or hospitalization. Overall, hospital-based care was reduced by about 50%. A control group did not see any such reductions.
“The most exciting part was the impact on emergency room visits and hospitalizations, which is a pretty dramatic finding. It was highly statistically significant, so not at all likely to be a chance finding,” Sachs said. “One of the aims of our grant was to try to keep people at home, and so we did that in a rather impressive fashion. It’s better for the patients and families and then, from a health care policy or payer perspective, that kind of dramatic decrease in ER visits and hospital admissions, if replicated and put into practice, could save quite a bit of money.”
