• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of hsresearchLink to Publisher's site
Health Serv Res. Feb 1992; 26(6): 801–817.
PMCID: PMC1069857

A randomized trial of the cost effectiveness of VA hospital-based home care for the terminally ill.

Abstract

All admissions to a 1,100-bed Department of Veterans Affairs (VA) hospital were screened to identify 171 terminally ill patients with informal caregivers who were then randomly assigned to VA hospital-based team home care (HBHC, N = 85) or customary care (N = 86). Patient functioning, and patient and caregiver morale and satisfaction with care were measured at baseline, one month, and six months. Health services utilization was monitored over the six-month study period and converted to cost. Findings included no differences in patient survival, activities of daily living (ADL), cognitive functioning, or morale, but a significant increase in patient (p = .02) and caregiver (p = .005) satisfaction with care at one month. A substitution effect of HBHC was seen. Those in the experimental group used 5.9 fewer VA hospital days (p = .03), resulting in a $1,639 or 47 percent per capita saving in VA hospital costs (p = .02). As a result, total per capita health care costs, including HBHC, were $769 or 18 percent (n.s.) lower in the HBHC sample, indicating that expansion of VA HBHC to serve terminally ill veterans would increase satisfaction with care at no additional cost.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Anderson GF, Steinberg EP. Hospital readmissions in the Medicare population. N Engl J Med. 1984 Nov 22;311(21):1349–1353. [PubMed]
  • Bloom BS, Kissick PD. Home and hospital cost of terminal illness. Med Care. 1980 May;18(5):560–564. [PubMed]
  • Cummings JE, Hughes SL, Weaver FM, Manheim LM, Conrad KJ, Nash K, Braun B, Adelman J. Cost-effectiveness of Veterans Administration hospital-based home care. A randomized clinical trial. Arch Intern Med. 1990 Jun;150(6):1274–1280. [PubMed]
  • Fleming ST, Kobrinski EJ, Long MJ. A multidimensional analysis of the impact of high-cost hospitalization. Inquiry. 1985 Summer;22(2):178–187. [PubMed]
  • Fortinsky RH, Granger CV, Seltzer GB. The use of functional assessment in understanding home care needs. Med Care. 1981 May;19(5):489–497. [PubMed]
  • Foster Z. Standards for hospice care: assumptions and principles. Health Soc Work. 1979 Feb;4(1):117–128. [PubMed]
  • Friedman B, Pauly MV. A new approach to hospital cost functions and some issues in revenue regulation. Health Care Financ Rev. 1983 Mar;4(3):105–114. [PubMed]
  • Greer DS, Mor V. An overview of National Hospice Study findings. J Chronic Dis. 1986;39(1):5–7. [PubMed]
  • Hughes SL, Cummings J, Weaver F, Manheim LM, Conrad KJ, Nash K. A randomized trial of Veterans Administration home care for severely disabled veterans. Med Care. 1990 Feb;28(2):135–145. [PubMed]
  • Kane RL, Wales J, Bernstein L, Leibowitz A, Kaplan S. A randomised controlled trial of hospice care. Lancet. 1984 Apr 21;1(8382):890–894. [PubMed]
  • Lawton MP, Moss M, Fulcomer M, Kleban MH. A research and service oriented multilevel assessment instrument. J Gerontol. 1982 Jan;37(1):91–99. [PubMed]
  • McCusker J, Stoddard AM. Effects of an expanding home care program for the terminally ill. Med Care. 1987 May;25(5):373–385. [PubMed]
  • Scitovsky AA. "The high cost of dying": what do the data show? Milbank Mem Fund Q Health Soc. 1984 Fall;62(4):591–608. [PubMed]
  • Ware JE, Jr, Davies-Avery A, Stewart AL. The measurement and meaning of patient satisfaction. Health Med Care Serv Rev. 1978 Jan-Feb;1(1):1–15. [PubMed]
  • Zimmer JG, Groth-Juncker A, McCusker J. A randomized controlled study of a home health care team. Am J Public Health. 1985 Feb;75(2):134–141. [PMC free article] [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...