利用临床信息学实现临终关怀的五重目标。

AMIA ... Annual Symposium proceedings. AMIA Symposium Pub Date : 2024-01-11 eCollection Date: 2023-01-01
Amanda Zaleski, Kelly J Thomas Craig, Eamon Caddigan, Hannah Yang, Zenon Cheng, Sherrie L McNutt, Alena Baquet-Simpson
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引用次数: 0

摘要

随着老年人口以前所未有的速度增长,在提供符合其文化背景的临终关怀方面存在巨大缺口。本研究介绍了一种以支付方为主导、以信息学为基础的方法,用于识别可能受益于 "体恤关怀计划"(CCP)的医疗保险会员,该计划旨在通过实现五重目标,为罹患晚期和/或局限生命疾病的会员提供专门的护理管理服务和支持。通过机器学习模型识别潜在参与者,然后由护士护理经理通过电话提供量身定制的外联服务。我们对倾向加权的医疗保险成员进行了一项回顾性观察队列分析,对参加或未参加 CCP 的死者进行了比较。与未参加临终关怀管理计划的逝者相比,该计划改善了逝者的临终关怀体验,同时提供了不分年龄、性别和地域的公平结果,并降低了住院率(-37%),同时减少了医疗支出(-59%)。
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Leveraging Clinical Informatics to Address the Quintuple Aim for End-of-Life Care.

As the population of older adults grows at an unprecedented rate, there is a large gap to provide culturally tailored end-of-life care. This study describes a payor-led, informatics-based approach to identify Medicare members who may benefit from a Compassionate CareSM Program (CCP), which was designed to provide specialized care management services and support to members who have end-stage and/or life-limiting illnesses by addressing the quintuple aim. Potential participants are identified through machine learning models whereby nurse care managers then provide tailored outreach via telephone. A retrospective, observational cohort analysis of propensity-weighted Medicare members was performed to compare decedents who did or did not participate in the CCP. This program enhanced the end-of-life care experience while providing equitable outcomes regardless of age, gender, and geography and decreased inpatient (-37%) admissions with concomitant reduced (-59%) medical spend when compared to decedents that did not utilize the end-of-life care management program.

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