[Outpatient forms of palliative care as predictors of outcome quality and costs of regional end-of-life care: a claims data-based cost-consequence analysis].

Abstract

Background: The quality of outcomes and cost-effectiveness of regional hospice and palliative care (PC) services vary greatly. This study examines the relationship between the different regional outpatient forms of PC and these two dimensions.

Methods: The retrospective analysis is based on the study population of 145,372 persons who were insured with the BARMER health insurance fund, who died between 2016 and 2019 and received PC in the last year of their life. The association of primary palliative care (AAPV), specially qualified and coordinated PC (BQKPmV), and specialist palliative homecare (SAPV) with quality- and cost-related outcomes was determined through multiple regression analyses, taking into account regional variability of these associations and controlling for other forms of PC as well as patient and residential district characteristics.

Results: AAPV in Rhineland-Palatinate, BQKPmV in Thuringia, and SAPV in Saxony-Anhalt and Berlin achieve an above-average impact on the quality of outcomes compared to the national average. The total costs of care in the last three months of life (except for the costs of ambulatory palliative care) are significantly reduced by AAPV. For SAPV, costs usually exceed potential savings, especially in North Rhine-Westphalia, with Berlin and Westphalia-Lippe being counter-examples. Whilst Westphalia-Lippe relies on a solidly effective, integrated, low-cost AAPV-SAPV model that benefits many people, Berlin represents a highly effective, low-cost SAPV model which, however, reaches fewer people.

Conclusion: New evidence of good practice regions offers starting points for tackling the challenge of quality-of-life-oriented, resource-efficient palliative care for a demographically growing number of people in need. Approaches that result in fewer people receiving care and higher costs and at best increase the quality of care for a few, should be critically scrutinized.