Improving Care of People with Serious Medical Illness: An Economic Research Agenda for Palliative Care (RP504)

Outcomes. 1. Recognize the types of high-value economic evidence and the key barriers to development of such evidence in palliative care 2. Explain the key elements of the proposed research agenda on supply-side, demand-side, and methodological factors 3. Appraise and question the proposed priorities Importance. While people with serious medical illnesses account disproportionately for health care spending, the expenditure typically yields poor value. The number of people living with serious illness increases each year as the population ages, and inequities are growing over time. Without robust economic evidence to inform policy related to serious medical illness, the current paradigm of poor-value care and growing inequities will persist. Objective(s). To develop a research strategy to extend and strengthen economic evidence on palliative care. Method(s). We convened an expert panel to develop a consensus-driven economic research agenda for palliative care. The panel included researchers in health economics, palliative and geriatric medicine, and health services research methods as well as payers, policymakers, and research funders. Results. The derived agenda was organized into questions on supply-side, demand-side, and methodological factors. Supply-side questions focused on payment policy and access, where provider reimbursement policies influence both care delivery and patient treatment choices. Demand-side factors emphasized preferences and future needs. We must improve understanding of what people need and value in order to improve care and outcomes. Methods can be improved in the short run with the expanded use of quasiexperimental approaches on routine data. In the longer term, researchers need a strategic plan to bridge data gaps and improve linkage. Conclusion(s). Evidence of poor outcomes, high costs, and persistent inequities for people with serious medical illness suggests substantial scope to improve the quality and value of care provided. Economic analyses are essential to inform decision making, but there is a marked lack of high-quality studies. Impact. A consensus-driven palliative care research agenda can encourage and guide potential funders and researchers to begin building the economic evidence base needed by public and private payers to improve care across settings and conditions.