Objective: Evaluate the process and the economic impact of an integrated palliative care program. Design: Comparative cross-sectional study. Location: Integrated Healthcare Organizations of Alto Deba and Goierri Alto-Urola, Basque Country. Participants: Patients dead due to oncologic and non-oncologic causes in 2012 (control group) and 2015 (intervention group) liable to need palliative care according to McNamara criteria. Interventions: Identification as palliative patients in primary care, use of common clinical pathways in primary and secondary care and arrange training courses for health professionals. Main measures: Change in the resource use profile of patients in their last 3 months. Propensity score by genetic matching method was used to avoid non-randomization bias. The groups were compared by univariate analysis and the relationships between variables were analysed by logistic regressions and generalized linear models. Results: One thousand and twenty-three patients were identified in 2012 and 1,142 patients in 2015. In 2015 doubled the probability of being identify as palliative patient in deaths due to oncologic (19-33%) and non-oncologic causes (7-16%). Prescriptions of opiates rise (25-68%) and deaths in hospital remained stable. Contacts per patient with primary care and home hospitalization increased, while contacts with hospital admissions decreased. Cost per patient rise 26%. Conclusions: The integrated palliative care model increased the identification of the target population. Relationships between variables showed that the identification had a positive impact on prescription of opiates, death outside the hospital and extension to non-oncologic diseases. Although the identification decreased admissions in hospital, costs per patient had a slight increase due to home hospitalizations.
Larrañaga, I., Millas, J., Soto-Gordoa, M., Arrospide, A., San Vicente, R., Irizar, M., … Mar, J. (2019). The impact of patient identification on an integrated program of palliative care in Basque Country. Atencion Primaria, 51(2), 80–90. https://doi.org/10.1016/j.aprim.2017.05.017