HEALTH CARE UTILIZATION OUTCOMES FOR PATIENTS ENROLLED IN A LATE-LIFE CARE INTERVENTION

Health systems in the U.S. are faced with increased utilization for patients in their last years of life. Care for patients with serious illness is complex and requires a greater number of clinicians and care settings. This can contribute to duplicative and unwanted medical procedures. As a large portion of the population approaches retirement, health systems must redouble efforts to better serve patients as they near the end of life. LifeCourse is a patient-centered intervention which leverages a layperson care guide to build upon an expanded set of palliative care domains. Care guides meet with patients, their family members and clinicians to help patients articulate goals, take part in decision making, and connect with resources. LifeCourse is a non-randomized prospective study of 450 intervention and 448 usual care patients followed between October 2012 and June 2016. Patients and controls were selected based on diagnosis, disease progression, and comorbidity mix. Using zero-inflated negative binomial regression models we tested whether participation in LifeCourse resulted in decreased utilization on three outcomes, ED visits, inpatient days, and ICU stays. On average, patients in the intervention group experienced 25% fewer inpatient days (IRR = 0.75; 95% CI: 0.62–0.91) and 57% fewer ICU stays (IRR = 0.43; 95% CI: 0.24–0.77). We did not detect a difference in the number of ED visits (IRR = 0.85; 95% CI: 0.72–1.01). Our findings suggest that when a whole-person approach to care is used and patients’ preferences are known there is a beneficial impact on health care utilization in late-life.