High-cost/high-need (HCHN) adults and the healthcare systems that provide their care may benefit from a new patient-centered model of care involving a dedicated physician and nurse team who coordinate both clinical and social services for a small patient panel.
Evaluate the impact of a Complex Care Program (CCP) on likelihood of patient survival and hospital admission in 180 days following empanelment to the CCP.
Retrospective cohort study using a quasi-experimental design with CCP patients propensity score matched to a concurrent control group of eligible but unempaneled patients.
Kaiser Permanente Mid-Atlantic States (KPMAS) during 2017–2018.
Nine hundred twenty-nine CCP patients empaneled January 2017–June 2018, 929 matched control patients for the same period.
The KPMAS CCP is a new program consisting of 8 teams each staffed by a physician and nurse who coordinate care across a continuum of specialty care, tertiary care, and community services for a panel of 200 patients with advanced clinical disease and recent hospitalizations.
Time to death and time to first hospital admission in the 180 days following empanelment or eligibility.
Compared to matched control patients, CCP patients had prolonged time to death (hazard ratio [HR]: 0.577, 95% CI: 0.474, 0.704), and CCP decedents had longer survival (median days 69.5 vs. 53.0, p=0.03). CCP patients had similar time to hospital admission (HR: 1.081, 95% CI: 0.930, 1.258), with similar results when adjusting for competing risk of death (HR: 1.062, 95% CI: 0.914, 1.084).
Non-randomized intervention; single healthcare system; patient eligibility limited to specific conditions.
The KPMAS CCP was associated with significantly reduced short-term mortality risk for eligible patients who volunteered to participate in this intervention.
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The authors would like to acknowledge the 2017–2018 KPMAS Complex Care Program physicians (Drs. F. Abdulsalam, S. Flagg, C. Freeman, F. Freisinger, L. Luo, K. Nagi, S. Nokuri, J. Swett, R. Yelamanchi), nurses (Ms. J. Garza, R. Leonard, E. McKinney), and administrative team (Ms. C. Campbell, Mr. C. Ma) who provided helpful suggestions during presentations of interim results at steering committee meetings.
The KPMAS Community Benefit Fund provided funds for the evaluation. It had no role in the design of the study; the collection, analysis, and interpretation of the data; and the decision to approve publication of the finished manuscript.
Conflict of Interest
The authors have no financial conflicts of interest to disclose. Drs. McCarthy, Mendiratta, and Roblin are affiliated with the medical group which designed and implemented the intervention.
The evaluation protocol has been reviewed, approved, and monitored by the Institutional Review Board of Kaiser Permanente Mid-Atlantic States (IRB Protocol number MA-16-138).
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Question: Does an intervention focused on the secondary and tertiary care coordination and palliative care needs of high-cost/high-need adults modify their short-term risk of repeat hospitalization and mortality?
Findings: The intervention implemented at Kaiser Permanente Mid-Atlantic States significantly reduced the 180-day mortality hazard ratio [HR] by 42.3% but did not significantly change the 180-day medical/surgical admission HR—compared to a matched patient cohort.
Meaning: An intervention designed to address the specific care requirements of high-cost/high-need adults achieved significantly reduced short-term mortality HR.
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Roblin, D.W., Segel, J.E., McCarthy, R.J. et al. Comparative Effectiveness of a Complex Care Program for High-Cost/High-Need Patients: a Retrospective Cohort Study. J GEN INTERN MED 36, 2021–2029 (2021). https://doi.org/10.1007/s11606-021-06676-x