An Evaluation of the Advanced Illness Management (AIM) Program: Increasing Hospice Utilization in the San Francisco Bay Area

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Abstract
In the Medicare population, end-of-life care is fragmented and hospice is underutilized. Evidence suggests that hospice care is associated with increased patient/family satisfaction and reductions in overall health care costs. Advanced Illness Management (AIM) is a home-based program established to ease the transition between curative and comfort care for seriously ill patients who lack coordinated hospital, home health, and hospice care. Measure the impact of the AIM program on the discharge disposition of participating home health patients. Retrospective cohort study. A total of 435 patients who received home health services through the Sutter Visiting Nurse Association and Hospice (SVNA&H) and who were discharged between 2003 and September 2005 were included in this study. Participants were selected based on a life expectancy of 6 months or less and additionally matched on prognosis of current episode of illness and symptom status. Intervention patients were compared to those receiving usual home health care at two SVNA&H branches. In the within-branch comparison, a 28% difference was observed in the number of hospice referrals between patients who received the AIM intervention and Usual Care I (47% AIM; 33% UCI, p = 0.003). When patients receiving the AIM intervention were compared to patients from another branch, Usual Care II, a 67% difference emerged (47% AIM; 16% UCII, p < 0.0001). Among African American patients, 60% and 73% more patients were referred to hospice when AIM patients were compared to Usual Care I and Usual Care II patients, respectively (p < 0.01). These differences persisted after controlling for symptom status, patient demographics and home health length of stay. The AIM program was successful at increasing hospice utilization through a targeted intervention focused on palliative and end-of-life care, increased patient education and decision making, and a dynamic treatment approach. The finding of increased utilization by African Americans, a population traditionally reluctant to use hospice, was particularly noteworthy.