Quality of Life Increases for Patients Receiving Team Home-Based Health Care, But So Do Costs
When compared to the traditional single-person care model, home-based primary care (HBPC) administered by teams of providers "significantly" improved the quality of life for terminally ill patients, as well as the satisfaction with care for non-terminally ill patients, a new Veterans Affairs study reveals. However, the team-based model costs more. The study, published in the Dec. 13 issue of the Journal of the American Medical Association, was conducted from October 1994 to September 1998 at 16 VA medical centers with an HBPC program. Participants were homebound and fell into to one of two categories: they were terminally ill or non-terminally with chronic health care problems, such as severe disability or chronic obstructive pulmonary disease. Most of the participants were at "medium-to-high" risk of rehospitalization.
With regard to health-related quality of life areas such as mental health and bodily pain, terminally ill patients in the test group that received team-based home care "improved significantly" compared to those in the control group that received traditional care. However, with regard to satisfaction of care, team-based and traditional care terminally ill patients had the same level of overall satisfaction. In contrast, non-terminally ill patients in the team-based group experienced "significant increases" in care satisfaction. In addition, 11% fewer patients receiving team-based care were rehospitalized within the first six months, although this reduction was not sustained at 12 months. The study also showed that the satisfaction and health status of preexisting caregivers for the homebound could be increased by using the team-based model. With regard to the terminally ill, caregivers reported "significant ... improvements" in all aspects of their health-related quality of life except for vitality and general health. The greatest improvements for this group were in the area of emotional role function. With regard to the non-terminally ill, caregivers of non-terminal patients also experienced "pronounced" improvements in various areas, including social functioning, general health and physical function.
While VA hospital readmission costs were lower for the team-based patients at six months, home-based care and nursing home care costs were "significantly higher" for this group. Total VA costs were 18% higher for the home-based group than for the control group, an expense partially offset by a 9% reduction in the home-based group's private sector or non-VA costs. Total costs of VA and private sector care were 12.1% higher for the team-based group, or about an additional $282 per client per month (Hughes et al., JAMA, 12/13).