Economic (gross cost) analysis of systematically implementing a programme of advance care planning in three Irish nursing homes.

dc.contributor.authorO'Sullivan, Ronan
dc.contributor.authorMurphy, Aileen
dc.contributor.authorO'Caoimh, Rónán
dc.contributor.authorCornally, Nicola
dc.contributor.authorSvendrovski, Anton
dc.contributor.authorDaly, Brian
dc.contributor.authorFitzgerald, Carol
dc.contributor.authorTwomey, Cillian
dc.contributor.authorMcGlade, Ciara
dc.contributor.authorMolloy, D. William
dc.contributor.funderAtlantic Philanthropiesen
dc.contributor.funderHealth Research Boarden
dc.contributor.funderIrish Hospice Foundationen
dc.date.accessioned2017-01-20T15:53:25Z
dc.date.available2017-01-20T15:53:25Z
dc.date.issued2016-04-26
dc.date.updated2017-01-20T15:42:02Z
dc.description.abstractBackground: Although advance care planning (ACP) and the use of advanced care directives (ACD) and end-of-life care plans are associated with a reduction in inappropriate hospitalisation, there is little evidence supporting the economic benefits of such programmes. We assessed the economic impact (gross savings) of the Let Me Decide (LMD) ACP programme in Ireland, specifically the impact on hospitalisations, bed days and location of resident deaths, before and after systematic implementation of the LMD-ACP combined with a palliative care education programme. Methods: The LMD-ACP was introduced into three long-term care (LTC) facilities in Southern Ireland and outcomes were compared pre and post implementation. In addition, 90 staff were trained in a palliative care educational programme. Economic analysis including probabilistic sensitivity analysis was performed. Results: The uptake of an ACD or end-of-life care post-implementation rose from 25 to 76 %. Post implementation, there were statistically significant decreases in hospitalisation rates from baseline (hospitalisation incidents declined from 27.8 to 14.6 %, z = 3.96, p < 0.001; inpatient hospital days reduced from 0.54 to 0.36 %, z = 8.85, p < 0.001). The percentage of hospital deaths also decreased from 22.9 to 8.4 %, z = 3.22, p = 0.001. However, length of stay (LOS) increased marginally (7–9 days). Economic analysis suggested a cost-reduction related to reduced hospitalisations ranging between €10 and €17.8 million/annum and reduction in ambulance transfers, estimated at €0.4 million/annum if these results were extrapolated nationally. When unit costs and LOS estimates were varied in scenario analyses, the expected cost reduction owing to reduced hospitalisations, ranged from €17.7 to €42.4 million nationally. Conclusions: Implementation of the LMD-ACP (ACD/end-of-life care plans combined with palliative care education) programme resulted in reduced rates of hospitalisation. Despite an increase in LOS, likely reflecting more complex care needs of admitted residents, gross costs were reduced and scenario analysis projected large annual savings if these results were extrapolated to the wider LTC population in Ireland.en
dc.description.sponsorshipThe Centre for Gerontology and Rehabilitation is supported by Atlantic Philanthropies, the Health Service Executive of Ireland, the Health Research Board of Ireland and the Irish Hospice Foundation.en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationO’Sullivan, R., Murphy, A., O’Caoimh, R., Cornally, N., Svendrovski, A., Daly, B., Fizgerald, C., Twomey, C., McGlade, C. and Molloy, D. W. (2016) 'Economic (gross cost) analysis of systematically implementing a programme of advance care planning in three Irish nursing homes', BMC Research Notes, 9(1) 237 (10pp). doi:10.1186/s13104-016-2048-9en
dc.identifier.doi10.1186/s13104-016-2048-9
dc.identifier.endpage237-10en
dc.identifier.issn1756-0500
dc.identifier.issued1en
dc.identifier.journaltitleBMC Research Notesen
dc.identifier.startpage237-1en
dc.identifier.urihttps://hdl.handle.net/10468/3492
dc.identifier.volume9en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.rights© 2016 O’Sullivan et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stateden
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en
dc.subjectAdvanced care planningen
dc.subjectAdvanced care directivesen
dc.subjectEconomic analysisen
dc.titleEconomic (gross cost) analysis of systematically implementing a programme of advance care planning in three Irish nursing homes.en
dc.typeArticle (peer-reviewed)en
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