Evaluation of a Home-Based, Nurse Practitioner–led Advanced Illness Care Program

Published in: Journal of the American Medical Directors Association, Volume 22, Issue 11, pages 2389–2393 (November 2021). doi: 10.1016/j.jamda.2021.05.013

Posted on RAND.org on June 01, 2022

by Natalie Ernecoff, Stefanie C. Altieri-Dunn, Andrew Bilderback, Cindy L. Wilson, Susan Saxon, Namita Ahuja Yende, Robert Arnold, Michael Boninger

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Objectives

In the United States, people with serious illness often experience gaps and discontinuity in care. Gaps are frequently exacerbated by limited mobility, need for social support, and challenges managing multiple comorbidities. The Advanced Illness Care (AIC) Program provides nurse practitioner–led, home-based care for people with serious or complex chronic illnesses that specifically targets palliative care needs and coordinates with patients' primary care and specialty health care providers. We sought to investigate the effect of the AIC Program on hospital encounters [hospitalizations and emergency department (ED) visits], hospice conversion, and mortality.

Design

Retrospective nearest-neighbor matching.

Setting and Participants

Patients in AIC who had ≥1 inpatient stay within the 60 days prior to AIC enrollment to fee-for-service Medicare controls at 9 hospitals within one health system.

Methods

We matched on demographic characteristics and comorbidities, with exact matches for diagnosis-related group and home health enrollment. Outcomes were hospital encounters (30- and 90-day ED visits and hospitalizations), hospice conversion, and 30- and 90-day mortality.

Results

We included 110 patients enrolled in the AIC Program matched to 371 controls. AIC enrollees were mean age 77.0, 40.9% male, and 79.1% white. Compared with controls, AIC enrollees had a higher likelihood of ED visits at 30 [15.1 percentage points, confidence interval (CI) 4.9, 25.3; P = .004] and 90 days (27.8 percentage points, CI 16.0, 39.6; P < .001); decreased likelihood of hospitalization at 30 days (11.4 percentage points, CI –17.7, –5.0; P < .001); and a higher likelihood of converting to hospice (22.4 percentage points, CI 11.4, 33.3; P < .001).

Conclusions

The AIC Program provides care and coordination that the home-based serious illness population may not otherwise receive.

Implications

By identifying and addressing care needs and gaps in care early, patients may avoid unnecessary hospitalizations and receive timely hospice services as they approach the end of life.

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