Evidence map›Paper›PMID 27574868›Full record

ArticleJournal of palliative medicine2017

The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization.

Dana Lustbader, Mitchell Mudra, Carole Romano, Ed Lukoski, Andy Chang, James Mittelberger, Terry Scherr, David Cooper

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of palliative medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 73 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
73citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

73 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  11. [S1 guideline on sustainability in intensive care and emergency medicine].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025
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13 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Dana Lustbader1 Department of Palliative Care, ProHEALTH Care , Lake Success, New York.
Mitchell Mudra2 Optum Center for Palliative and Supportive Care , Eden Prairie, Minnesota.
Carole Romano3 ProHEALTH Medical Management, An Optum Company , Lake Success, New York.
Ed Lukoski3 ProHEALTH Medical Management, An Optum Company , Lake Success, New York.
Andy Chang3 ProHEALTH Medical Management, An Optum Company , Lake Success, New York.
James Mittelberger2 Optum Center for Palliative and Supportive Care , Eden Prairie, Minnesota.
Terry Scherr4 Healthcare Analytics , OptumCare, Eden Prairie, Minnesota.
David Cooper5 ProHEALTH Care , Lake Success, New York.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPeople with advanced illness usually want their healthcare where they live-at home-not in the hospital. Innovative models of palliative care that better meet the needs of seriously ill people at lower cost should be explored.

objectivesWe evaluated the impact of a home-based palliative care (HBPC) program implemented within an Accountable Care Organization (ACO) on cost and resource utilization.

methodsThis was a retrospective analysis to quantify cost savings associated with a HBPC program in a Medicare Shared Savings Program ACO where total cost of care is available. We studied 651 decedents; 82 enrolled in a HBPC program compared to 569 receiving usual care in three New York counties who died between October 1, 2014, and March 31, 2016. We also compared hospital admissions, ER visits, and hospice utilization rates in the final months of life.

resultsThe cost per patient during the final three months of life was $12,000 lower with HBPC than with usual care ($20,420 vs. $32,420; p = 0.0002); largely driven by a 35% reduction in Medicare Part A ($16,892 vs. $26,171; p = 0.0037). HBPC also resulted in a 37% reduction in Medicare Part B in the final three months of life compared to usual care ($3,114 vs. $4,913; p = 0.0008). Hospital admissions were reduced by 34% in the final month of life for patients enrolled in HBPC. The number of admissions per 1000 beneficiaries per year was 3073 with HBPC and 4640 with usual care (p = 0.0221). HBPC resulted in a 35% increased hospice enrollment rate (p = 0.0005) and a 240% increased median hospice length of stay compared to usual care (34 days vs. 10 days; p < 0.0001).

conclusionHBPC within an ACO was associated with significant cost savings, fewer hospitalizations, and increased hospice use in the final months of life.

Indexed as

Accountable Care OrganizationsAgedAged, 80 and overCost SavingsFemaleHealth Care CostsHome Care ServicesHumansMaleMedicareNew YorkPalliative CarePrimary Health CareRetrospective StudiesUnited States

Identifiers

PMID27574868
PMCPMC5178024

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.