Saiatu brief

Impact of the Provision of Social Care within a Palliative Care Programme on Healthcare Costs: The SAIATU Project

“The coordination of social and health resources in palliative care is not an element of excellence, but rather a necessity."

Herrera E ( Washington, 2006 World Cancer Congress)

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Background & Scope of the Project

-  Description of the specialised services offered to end-of-life patients & their families under the SAIATU Programme

-  Costs of the various services that have been provided under the SAIATU Programme

-  Satisfaction of family members with the care received under the SAIATU Programme - Impact that the SAIATU Programme could have on the use of healthcare resources (including cost savings) in the care of end-of-life patients

The SAIATU Project: In-home social support services complementary to pal l iat ive c l in ica l ser v ices , to improve the comprehensiveness of care provided to individuals with advanced terminal illnesses & their families

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General Comments

Pilot studies in palliative care have been successful in terms of quality, effectiveness, efficiency & cost-savings. The prevalence of chronic illness & lack of home carers should start to stimulate the development, within palliative care, of sufficient support from social community support networks to ensure that healthcare provided is actually useful.

It is necessary to set up projects that respond to this reality & make an effort to assess their effectiveness & efficiency.

What is required?

Description & Analysis of the SAIATU Programme

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Methodology

Document analysis

•  National & international experience to date on social care & accompaniment in palliative care

•  Scientific literature, websites of related institutions & organisations •  Idenfication of successful programmes, tasks, roles, human resources, pilot

studies, etc.

Qualitative analysis

•  Questionnaire •  Face-to-face interveiws with professionals •  Types of services & the way they are provided, roles/tasks of the

professionals, training, description of the programme, etc.

Quantitative analysis

•  Review of records •  Retrospective analysis •  Demographic characteristics, social value, admission to the programme,

activities, bereavement, place of death, etc.

¿Qué necesidades hay?

Description of the SAIATU Programme

A. Background B. Programme Vision & Mission

C. Objectives D. Beneficiaries

E. Portfolio of Services F. Human Resources & Roles

H. Organisation of the Activities I. Documentation & Data Management System J. Cost Structure

Analysis of the Programme Activities

A. Population B. Sociodemographic Characteristics

C. Admission to the Programme D. Data on Activities

E. Data on Costs F. Use of Resources

G. Preferences & Place of Death H. Family Satisfaction


Overview of the Results



Description of the SAIATU Programme A. Background B. Programme Vision & Mission

Vis

ion

“To broaden our palliative care framework from a social perspective in order to provide high-quality care that responds to the social needs of patients & their families”

Mis

sion

“To provide specialised support & accompaniment to patients with terminal illnesses & their families through a continuous social care service to enable patients to stay at home during the end-of life phase”

Programme for specialised in-home social care connected with palliative care, tailored to the needs of individuals with advanced illnesses & their families.


C. Objectives

1. To provide support, face-to-face &/or by telephone, for the care & emotional accompaniment of patients & families at any time of day, even at night (in exceptional circumstances), every day of the year 2. To collaborate with other palliative care resources in the Basque Country to ensure comprehensive care through specialised social support 3. To facilitate in-home care & meet the wishes of patients who prefer to die at home & their families, alleviating pain & offering accompaniment & support in the care of physical symptoms, as well as emotional & social needs 4. To support family members throughout the course of the illness & after the death in the bereavement period




D. Beneficiaries E. Portfolio of services

Definition of the target population

Patients with cancer

Patients with progressive chronic illnesses

Portfolio of services Care protocols

Information Communication

Accompaniment

Respite care Bereavement support

Care support BADLs

Specialised care

Monitoring of symptoms

24x7x365

Patients

Family members




F. Human Resources & Roles H. Organisation of the Activities I. Documentation & Data Management System

Human Resources & Roles

Shared Roles

Coord

Nurses (RNs & aux.)

Social Workers

Doctors

Organisation of the Activities

Provision of services -  Face-to-face -  By telephone

Referral of patients Operation of the programme

Documentation & Data Management System

Description of the documentation system




Descripción del programa SAIATU J. Cost structure

Total costs of the SAIATU Programme

ITEMS To 31/12/2011 % of total costs To 31/10/2011

Personnel costs 114,826.69 68.5% 97,536.82

Insurance 955.35 0.6% 781.65

Health & safety measures 165.20 0.1% 135.16

Medical examinations 312.00 0.2% 255.27

Consultancy/Advice 599.43 0.4% 490.44

Telephone charges 1.472.72 0.9% 1,012.37

Total 118,331.39 70.5% 100,211.72

UNFORESEEN ADDITIONAL COSTS To 31/12/2011 % of total costs To 31/10/2011

Training/Education 3,000.00 1.8% 2,250.00

Co-working costs 990.00 0.6% 810.00

Communication costs 2,485.00 1.5% 2,033.18

Salary increases (new pay deal) 42,924.08 25.6% 35,119.70

TOTALS 167,730.46 100.0% 140,424.60


22,9%14,3%

17,1%8,6%8,6%8,6%

5,7%2,9%2,9%2,9%2,9%2,9%

ProstataColon

PulmónCerebral

MamaRenal

EstómagoEpidermiode del labio

EsófagoMesotelioma pleural

RectoUrotelial

Description & Analysis of the SAIATU programme programm

Programme Activities A. Population B. Sociodemographic characteristics

Period Feb-Oct 2011

n = 40

Cancer diagnoses: 90% (n=35). Non-cancer diagnoses: 10% (n= 4)

Amyotrophic lateral sclerosis

Bone marrow aplasia

Ischaemic cardiomyopathy

Chronic renal failure

Mean age: 75 years old [SD11.89]

Marital status

Urothelial Rectum

Pleural Mesothelioma Oesophagus

Squamous cell Carcinoma of the lip

Stomach Renal Breast Brain Lung

Colon Prostate

. . . . .

.

.

.

.

. .

.


Description & Analysis of the SAIATU programme

Programme Activities A. Population B. Sociodemographic characteristics

Soci

al r

esou

rces

On admission to the SAIATU

Programme

No. of Families

(n=30)*

No social resources 9

With social resources 21

Private support & external carers 12

Economic resources 5

Technical resources 4

Requests for technical resources,

met by the programme in all cases

No. of Families

(n=12)*

Technical resources 10

Coordination with other services 2

*Analysis of cases in which there was recorded expenditure

100% role as primary caregiver •  57% partner •  38% children •  5% others (e.g., grandchildren,

nephews/nieces)

Role of the primary caregiver Social support

Social Assessment



Programme Activities C. Admission to the Programme

32 34 37 36

816

13 3

0

10

20

30

40

50

60

Diagnóstico Pronóstico Diagnostico Pronostico

Nv

No

Si

Awareness of the illness

Level of Independence Number of patients (n=38)* Rate

Independent 0 0%

Mild dependence 5 13.1%

Moderate dependence 10 26.3%

Severe dependence 9 23.7%

Complete dependence 14 36.9%

Diagnosis Prognosis Diagnosis Prognosis Level of Independence

NV No Yes


Weakness 42.8% Insomnia 8.6% Tiredness 42.8% Nausea 8.6% Pain 37.1% Vomiting 8.6% Dysphagia 31.4% Dyspnoea 5.7% Constipation 31.4% Coughing 5.7% Anorexia 28.6% Hiccups 5.7% Weight loss 11.4% Diarrhoea 5.7%

Confusion 2.8%

Existential suffering 31.4% Sadness 17.1% Depression 8.6% Anxiety 5.7% Apathy 2.8%

Dry mouth 25.7% Ulcers 20.0% Assistence needed for walking 17.1% Jaundice 5.7% Agony 2.8% Pruritus 2.8% Oedema 2.8% Aphonia 2.8%

Average of 5 symptoms /patient

Physical symptoms

Psychological & emotional aspects

End-of-life signs

Programme Activities C. Admisison to the Programme


Assessment of symptoms

Activity from February-October 2011: 40 patients

Total no. of visits 479

- Visits in the previous 3 days 72 15.1%

- Bereavement visits 69 14.4%

Total no. of telephone calls 467

- Bereavement calls 67 14.3%

Mean time on the programme 26.2 days [SD=34.50]

Feb Mar Abr May Jun Jul Ago Sep Oct

Evolución visitas 24,5 49,7 67,6 63,5 99,6 69,3 49,9 31,3 23,6

Evolución llamadas 9,2 28,7 55,3 41,3 104 83,4 60,9 54,7 30,3

Evolución pacientes en curso 1,67 3,14 3,89 3,14 7,28 6,17 4,53 3,25 1,85

0

20

40

60

80

100

120

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Programme Activities D. Data on Activities

Mean time on the programme → 26.2 days Mean no. of patients on the programme at any one time → 3.88


Visits Telephone calls Patients registered

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Activity Total time (hours) % of total time Care/support visits 1,006.50 79% Bereavement visits 119 9% Monitoring telephone calls 126.3 10% Bereavement telephone calls 18.54 1% Total 1,270.34 100%

Distribution of time by type of service provided

Activity Total cost (€) No. Unit cost (€) Care/support visits 111,259.70 410 271.37 Bereavement visits 13,154.40 69 190.64 Monitoring telephone calls 13,961.44 400 34.90 Bereavement telephone calls 2,049.07 67 30.58

Total 140,424.60 946 148.44

Unit costs per activity

Programme activities E. Data on Costs


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Programme Activities F. Use of Resources

Activity Mean 95% Confidence Interval Nurse home visits 6.86 [0.97 – 12.74] Nurse health centre appointments 3.29 [2.21 – 4.36] GP Home visits 5.11 [2.91 – 7.32] GP health centre appointments 5.09 [4.00 – 6.17] Specialist outpatient appointments 2.34 [1.28 – 3.41] Hospital A&E attendances 1.03 [0.64 – 1.41] Hospital admissions 0.63 [0.33 – 0.93] Inpatient bed days 8.87 [4.38 – 13.35] Days on the HaH programme 31.92 [18.91 – 44.93]

Activity in primary care, specialised care & the HaH service for SAIATU patients


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(0: low,10: very high) Satisfaction

0 0 (0%)

1 0 (0%)

2 0 (0%)

3 0 (0%)

4 0 (0%)

5 2(14%)

6 0 (0%)

7 0 (0%)

8 1 (7%)

9 1(7%)

10 10 (71%)

79.5% died at home vs. 20.5% died in hospital Overall satisfaction rating (14 relatives)

Programme activities G. Preferences & place of death H. Family satisfaction


“In these difficult economic times, the argument for good quality end-of-life care has moved away from ethical to economic considerations”.

(Eugene Murray, 2012)

The Programme’s Impact on Use of Healthcare Resources

The Programme’s Impact on Healthcare Resources use

Definition of the groups

Retrospective observational cohort study on the intensity of care (resource use) provided to end-of-life patients & their families under the SAIATU programme vs. traditional healthcare (primary care [PC] + specialised care [SC], with or without support from hospital-at-home [HaH] teams)

SAIATU

PC + SC

PC + SC + HaH

Exposed group composed of cancer patients cared for under the SAIATU programme from the start of the programme, 1st Feb 2011, to the cut-off date, 31st Oct 2011 Unexposed group (not on the SAIATU programme) composed of cancer patients cared for through PC + SC on a outpatient & inpatient basis, but not the HaH service

Unexposed group (not on the SAIATU programme) composed of cancer patients cared for through PC + SC on an outpatient, inpatient & hospital-at-home basis (HaH).

Note: we are using PC to stand for primary care, NOT palliative care

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Comparative Analysis of the Intensity of Healthcare

SAIATU PC+SC p1 PC+SC+HaH p2

Nurse home visits 0.86

[0.97 – 12.74]

1.42

[0.38 – 2.46]

0.999 2.26

[0.71 – 3.81]

0.997

Nurse health centre appointments

3.29

[2.21 – 4.36]

3,34

[1.66 – 5.02]

0.939 2.12

[1.35 – 2.89]

0.980

GP home visits 5.11

[2.91 – 7.32]

1.68

[0.65 – 2.71]

0.999 2.06

[1.08 – 3.04]

0.996

GP health centre appointments

5.09

[4.00 – 6.17]

4.36

[3.54 – 5.18]

0.878 3.66

[2.62 – 4.70]

0.985

Total primary care visits + appointments

20.34

[13.31 – 27.37]

10.80

[8.18 – 13.42]

0.999 10.10

[7.24 – 12.96]

0.999

[1] Comparison: SAIATU vs. PC+SC [2] Comparison: SAIATU vs. PC+SC+HaH

Differences in Intensity of Healthcare between the 3 groups: Primary Care

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Comparative Analysis of the Intensity of Healthcare .

[1] Comparison: SAIATU vs. PC+SC [2] Comparison: SAIATU vs. PC+SC+HaH

SAIATU PC+SC p1 PC+SC+HaH p2 Specialist outpatient appointments

2.34

[1.28 – 3.41]

4.68

[3.34 – 6.02]

0.001* 4.30

[3.30 – 5.30]

0.001*

Hospital A&E attendances

1.03

[0.64 – 1.41]

1.86

[1.53 – 2.19]

0.000* 1.40

[1.10 – 1.70]

0.42*

Hospital admissions

0.63

[0.33 – 0.93]

1.82

[1.55 – 2.09]

0.000* 1.56

[1.22 – 1.90]

0.000*

Inpatient bed days

8.87

[4.38 – 13.35]

19.17

[15.13 – 23.20]

0.001* 23.88

[16.49 – 31.28]

0.006*

Days on the HaH programme

31.92

[18.91 – 44.93]

21.39

[14.49 – 28.29]

0.976

Differences in Intensity of Healthcare between the 3 groups: Specialised Care

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Comparative Analysis of the Intensity of Healthcare

0

2

4

6

8

10

12

14

16

SAIATU AP+AE AP+AE+HaD

0

1

2

3

4

5

6

7

8

No. of outpatient appointments

0

2

4

6

8

10

12

14

16

18

20


0

1

2

3

4

5

6

No. of A&E attendances

0%

10%

20%

30%

40%

50%

60%


0

1

2

3 ó +

No. of hospital admissions

2.34 4.68 4.30

Mean values in blue

1.03 1.86 1.40

0.59 1.82 1.56

SAIATU PC+SC PC+SC+HaH SAIATU PC+SC PC+SC+HaH

SAIATU PC+SC PC+SC+HaH

≥ 9

≥ 3

No.

or %

of p

atie

nts

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SAIATU PC+SC p1 PC+SC+HaH p2 Cost per activity 6.719

[4.082-9.356]

15.326

[12.224-18.428]

<0.001*

Cost per activity + days on programmes

18.709

[13.177-24.241]

23.431

[18.247-28.617]

0.343

Note: * values for the SAIATU group were significantly lower by one-tailed Mann-Whitney U test + Mean & 95% confidence interval

The mean cost per activity was significantly lower for the SAIATU than for the PC+SC group (p<0.001). The difference between the costs related to the SAIATU with HaH group & the PC+SC+HaH group was not statistically significant (p=0.343).

Comparative Analysis of Costs related to the Intensity of Healthcare

Conclusions - The present project organises the new portfolio of services provided by a social care service within palliative care. -  Despite being a pilot study (i.e., the performance is expected to improve in the future), the SAIATU Programme shows how resources developed from a social care perspective, can be cost-effective & efficient for a healthcare system:

-  Reducing the use of hospital resources & associated costs -  Promoting an increase in at-home treatment with a

greater participation of primary care professionals -  While being rated as satisfactory by families

- With the lack of previous examples, SAIATU could become a model programme in the field. In this study, we observed a great impact on cost efficiency but the data used were retrospective; accordingly, the scale of the programme should be extended & a prospective study undertaken to validate these preliminary results.

- For this, the first steps need to be defining the services within the social sector in detail, as well as clarifying the vision, mission, strategic plan, processes, etc. of the programme.

“The inclusion of social services in the provision of palliative care is the

natural way to expand”.

(Bosanquet)

Enterprising Solutions for Health (EH) S.L. Edificio Galia Puerto, 1ª Planta

Crtra. de la Esclusa, 11. 41011 Seville, Spain

Tel. & Fax: (+34) 955 658276 www.es-health.com

Saiatu brief

Health & Medicine

Transcript of Saiatu brief