Date of Award

5-15-2015

Degree Type

Capstone Project

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Rodney Lyn, Ph.D.

Second Advisor

Sheryl Strasser, Ph.D.

Abstract

Background: By 2050, 27 million people will need some type of long-term care service, most of whom will have multiple chronic diseases. The population of Americans aged 65 years or older during the next 25 years to about 72 million. Long-term care and end-of-life care is going to continue growing as a significant healthcare burden.

Purpose/Approach: This review seeks to examine literature surrounding home-based palliative care in terms of 1) clinical effectiveness, 2) cost, 3) cost-effectiveness, 4) quality of life and patient satisfaction, and 5) recommendations for healthcare policy and practices.

Review of Literature: Evidence shows that home-based palliative care compared to palliative care in other environments may result in fewer hospitalizations, fewer hospital days, fewer ED visits, and fewer physician office visits. It reduces the likelihood of readmission to a hospital within 30 days and increases the likelihood of completing an advanced directive. It has shown to be cost-effective and result in lowered spending at a healthcare system and an individual level. Home-based care patients and their families report high levels of quality of life.

Recommendations: Recommendations that will help remove barriers to care include revising the Medicare hospice benefit to have less restrictive eligibility for home-based care, providing incentives to healthcare providers for discussing and integrating palliative care, and systematically training and educating health professionals on palliative care issues.

Conclusion: Ensuring affordable and timely home-based palliative care to this population is a critical step in reducing healthcare costs and improving quality of life.

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