Costs of Service Provision over the Palliative Care Trajectory

Presenter: Lisa Masucci, University of Toronto

Abstract

Introduction: There has been a dramatic shift in the provision of palliative care from hospitals to in-home care. The characterization and magnitude of this change in the site of delivery in terms of resource costs remain unknown. This study measured direct costs associated with home-based palliative care, and specifically, visits by physicians, nurses, and personal support workers as well as ambulatory resource costs.

Methods: Study participants were recruited from the Temmy Latner Center for Palliative Care (TLCPC), a regional palliative care program based in Toronto, Canada. One hundred and thirty-six palliative patients and their family caregivers participated in the study. Information regarding service use was obtained through structured telephone interviews with family caregivers.

Results: The mean total direct cost of care per patient for ambulatory and home-based services was $ 5,055 per month (2006 CDN). The largest component of these costs (74%) was comprised of services provided by personal support workers (mean monthly cost =$2,941 (2006 CDN)). The mean monthly cost of nursing visits was $605 (2006 CDN). Ambulatory services, which consisted of lab and diagnostic tests, hospital admissions, emergency room visits, and physician services comprised 6% of total direct monthly costs ($243 (2006, CDN)). Physician home visits made up the smallest cost component (3%) with $125 month (2006 CDN). Variation in the proportion of each direct cost component over the palliative care trajectory was also assessed. The findings may provide insight into resource allocation planning within home-based health care organizations. Specifically, fiscal restrain warrants consideration of program costs (and outcomes) in order to inform resource allocation decisions that advance the efficient, effective and equitable distribution of health care resources.(Funded by CIHR/CHSRF Health Services Chair: Health Care Settings and Canadians).