Characterizing the Financial Value of In-Home Palliative Care for Patients, Payers, and Hospitals.

BACKGROUND: The holistic and multidisciplinary approach of in-home palliative care (IHPC) is known to offer high-quality and cost-effective care for patients at the end of life. However, the financial benefits of upstream IHPC programs to hospitals, patients, and payers have not been fully characterized for patients with comorbid chronic conditions. AIM: To characterize the financial benefits that upstream IHPC offers to patients with multiple chronic conditions. METHODS: A structured retrospective patient record review was conducted on the number of emergency department (ED) visits, number of inpatient hospitalizations, hospital length of stay (LOS), and payments made to the hospital for all patients (N = 71) enrolled in an IHPC program between January 1, 2016, and June 30, 2016. Discharge history from each patient's medical record was also assessed. Comparisons were drawn between patients' LOS on IHPC and an equivalent time period prior to enrollment in IHPC. RESULTS: After patients enrolled in IHPC, average ED and inpatient utilization declined significantly by 41% (P = .01) and 71% (P < .001), respectively. The payers for health-care services realized a significant decline of US$2,201 (P < .001) in hospital payments per patient per month. Inpatient LOS was also significantly lower than expected once patients enrolled in the program (P = .01). CONCLUSIONS: As the need for chronic disease management continues to grow, managers of health systems, managed care organizations, and home health agencies should be cognizant of the financial value that IHPC has to offer.

Care for the most vulnerable children in Tanzania: a faith-based model of care and support for children affected by HIV.

In the fight against HIV and AIDS in sub-Saharan Africa, the plight of orphaned and vulnerable children was long overlooked. The first United Nations report on orphans and vulnerable children did not emerge until 2002 after more than two generations of children and youth had struggled to survive with limited family, institutional, or government support. The major social determinants of health for infants and children with one or more parents dying or dead from HIV include pervasive poverty, weak community social support systems, lack of policy commitment by governments or foreign donors, lack of access to anti-retroviral drugs, limited access to schools, and gender. In this paper, we present a model of care and support to the most vulnerable children (MVC) affected by HIV that brings together faith-based institutions in partnership with the government and community volunteers in 13 rural districts of Tanzania. Although still being implemented, the project has a number of valuable lessons learned for program managers, donors, and researchers working with faith-based organizations in the development and delivery of services to the most vulnerable children in a resource-limited setting.