| Abstrakt: |
This study aimed to evaluate the "Value-Based Healthcare" concept of an integrated palliative care (PC) program in Bogotá, Colombia, through the measurement of health outcomes and care costs in the last 3 months of life. A multicenter, retrospective cohort study that included patients ≥18 years old who died in 2020 due to medical conditions amenable to PC. The measured health outcomes included pain, wellbeing, comfort, quality of life (QOL), and satisfaction. We analyzed the behavior of overall care costs during the last 3 months of the patients' lives and controlled for the effect of exposure to the program, considering the disease type and insurance coverage, using a linear regression model, nearest-neighbor matching, and sensitivity analysis. Among patients exposed to the program, the mean pain score was 2.1/10 (± 1.3) and wellbeing was rated at 3.5/10 (± 1.0), comfort at 1.6/24 (± 1.3), QOL at 3.6/5.0 (± 0.17), and satisfaction at 9.3/100 (± 0.15). The positive changes in these scores were greater for patients who remained in the program for over 3 months. Cost reduction was demonstrated in the last 90 days of life, with statistically significant and chronologically progressive savings during the last 30 days of life exceeding 5 million pesos per patient (P <.05). This study demonstrated the success of PC in reducing pain, improving wellbeing and QOL, providing comfort, and ensuring high levels of satisfaction. Moreover, PC is an effective value-based healthcare strategy and can significantly enhance the efficiency of healthcare services by reducing end-of-life healthcare costs. • Patients nearing their end of life due to advanced chronic and terminal illnesses experience pain and suffering, which is associated with increased costs in the last 3 months of life. Palliative care (PC) has been shown to be effective in relieving pain and suffering and improving the quality of life of people with these illnesses. The "Value-Based Healthcare" concept seeks to bring efficiency by achieving outcomes that truly matter to patients and reduce healthcare costs. • There exists a dearth of literature addressing the concept of value-based healthcare in PC. This study was designed to determine the applicability of this concept to an integrated PC program in Bogotá, D.C., Colombia, through the measurement of the health outcomes and impact on the healthcare costs in the last 3 months of life. The goal is to promote the development of PC as a strategy for improving healthcare quality and efficiency. • This study delved into the implementation of the value-based healthcare concept within a PC program, highlighting the impact of initiating PC early in the disease trajectory on health outcomes and costs. It concludes that PC can be a value-based healthcare strategy to reduce the suffering of millions of people who will be at the end-of-life worldwide and to improve health services. [ABSTRACT FROM AUTHOR] |
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