Aging & Social Change: Ninth Interdisciplinary Conference

Abstract

The United States spends more on healthcare per capita than any other country (care of chronic diseases, disability, and end-of-life (EOL) care in the hospital are large portions of this). Most of the Medicare costs within the last year of life result from intensive life-sustaining care. Although most Americans prefer to die at home, over 20% of deaths take place in the hospital. This study aims to examine the effect of a multidisciplinary primary care team on rates of patient enrollment in hospice care, as well as patient location, at the time of death. Comparison between the percentage of MedVantage patients enrolled in hospice at time of death before vs after initiation of mobile NPs and to compare MedVantage data to national Medicare data. Determination of patient location at time of death including home. Hospice enrollment at death for the MedVantage clinic (n=51) and Medicare patients nationally was 70.6% and 48% respectively. Enrollment rates at death with Palliative Care NPs rose from 58% to 78%. 94.6% of MedVantage patients enrolled in hospice at time of death died in their homes. Early discussions of care with homebound patients leads to realistic goals of care congruent with the patient’s QOL. This is achieved with a multidisciplinary team, collaboration between PCPs, advanced practice providers, and healthcare provider team. Expansion of these services within a large hospital system may create sustainable use of Medicare funds, optimization of physician efforts, and improve family satisfaction with EOL care.