National Healthcare Disparities Report - LDI Health Economist

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Effectiveness of Care Supportive and Palliative Care Importance Demographics Number of Medicare nursing home residents ever admitted during the calendar year (2009)............................................................................................…….2.5 million (CMS, 2010b) Chapter 2 Supportive and Palliative Care Number of Medicare fee-for-service (FFS) home health patients xxxiii (2009).............3.3 million (CMS, 2010c) Number of Medicare FFS beneficiaries using Medicare hospice services (2009)....1.1 million (CMS, 2010d) Cost Total costs of nursing home care xxxiv (2009)...............................................................$137 billion (CMS, 2010b) Total costs of home health care xxxiv (2009) ................................................................$68.3 billion (CMS, 2010c) Medicare FFS payments for hospice services (2009 est.)........................................$12.1 billion (CMS, 2010d) Measures Disease cannot always be cured, and functional impairment cannot always be reversed. For patients with long-term health conditions, managing symptoms and preventing complications are important goals. Supportive and palliative care cuts across many medical conditions and is delivered by many health care providers. Supportive and palliative care focuses on enhancing patient comfort and quality of life and preventing and relieving symptoms and complications. Toward the end of life, hospice care provides patients and families with practical, emotional, and spiritual support to help cope with death and bereavement. Honoring patient values and preferences for care is also critical. Palliative and end-of-life care need to be “capable of promising dignity, comfort, companionship, and spiritual support to patients and families facing advanced illness or dying” (National Priorities Partnership, 2008). The NHQR and NHDR track several measures of supportive and palliative care delivered by home health agencies, nursing homes, and hospices. Five measures are presented in this section: n Relief of suffering: o Shortness of breath among home health care patients. o Pressure sores in nursing home residents. n Help with emotional and spiritual needs: o Right amount of emotional support among hospice patients. n Effective communication: o Enough information about what to expect among hospice family caregivers. xxxiii Medicare FFS patients represent only a portion of all home health patients. xxxiv Cost estimates for nursing home and home health services include only costs for freestanding skilled nursing facilities, nursing homes, and home health agencies and not those that are hospital based. 126 National Healthcare Disparities Report, 2011
Effectiveness of Care n High-quality palliative care: o Care consistent with patient’s wishes among hospice patients. Findings Relief of Suffering Outcome: Shortness of Breath Among Home Health Care Patients Shortness of breath is uncomfortable. Many patients with heart or lung problems experience difficulty breathing and may tire easily or be unable to perform daily activities. Doctors and home health staff should monitor shortness of breath and may give advice, therapy, medication, or oxygen to help lessen this symptom. Figure 2.55. Adult home health care patients who had less shortness of breath between the start and end of a home health care episode, by race and ethnicity, 2002-2009 75 White Black 70 65 Asian NHOPI 2008 Achievable Benchmark: 68% AI/AN >1 Race 75 70 65 Non-Hispanic White Hispanic 2008 Achievable Benchmark: 68% Chapter 2 Supportive and Palliative Care Percent 60 Percent 60 55 55 50 Z 0 2002 2003 2004 2005 2006 2007 2008 Key: NHOPI = Native Hawaiian or Other Pacific Islander; AI/AN = American Indian or Alaska Native. Source: Centers for Medicare & Medicaid Services, Outcome and Assessment Information Set, 2002-2009. Denominator: Adult nonmaternity patients completing an episode of skilled home health care. 2009 50 Z 0 2002 2003 2004 2005 2006 2007 2008 2009 n Between 2002 and 2009, the percentage of adult home health care patients who showed improvement in shortness of breath over the course of a home health episode increased for the total population from 53% to 60% (data not shown), as well as for each racial and ethnic group except Hispanics (Figure 2.55). n From 2005 to 2009, Hispanics were significantly less likely than non-Hispanic Whites to show improvement in shortness of breath. National Healthcare Disparities Report, 2011 127
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