Multidisciplinary Collaborative Care Reduces Costs, Improves End-of-Life Care for Patients With IPF

Despite idiopathic pulmonary fibrosis (IPF) carrying high morbidity and mortality rates and no cure, palliative care is rarely utilized, but a new study is making the argument for incorporating the care approach. According to the study, using an integrated palliative care approach not only improves the quality of end-of-life care but also reduces costs for patients with IPF.

The researchers began the intervention 8 years ago, when they implemented an early integrated palliative approach that focuses on symptom management and proactive advance care planning, as well as a multidisciplinary collaborative (MDC) care model that puts emphasis on integrating primary care and allied health teams.

“Even though [IPF] is life limiting, palliative care is rarely implemented, leading to high symptom burden, unmet care needs, and high healthcare resource use and costs,” explained the researchers, who added that another study “estimated IPF-attributable medical costs, excluding medications, to be close to $2 billion (US dollars) annually,” with half of the cost coming from hospitalizations, including end-of-life care.

To determine how costs, as well as quality of end-of-life care, would be affected by MDC care, the researchers of the current study collected data on 2768 patients who had an IPF diagnosis and died between January 2012 and December 2018. Of these patients, the researchers identified 3 groups: patients who received MDC care at their clinic (2.8%), patients who had specialist care (SC) (78.2%), and patients who had nonspecialist care (NSC) (18.9%).

What they saw was that total health care costs—estimated in Canadian dollars (C$)—in the last 3 months of life were approximately C$7700 lower for patients enrolled in the MDC care model than for patients receiving SC (C$15,100 vs C$22,800, respectively) and approximately C$5400 lower for patients enrolled in the MDC care model than for patients receiving NSC (C$15,100 vs C$20,500, respectively).

The differences in costs were primarily driven by differences in hospitalizations and emergency department visits. In the last 3 months of life, the median number of hospitalizations was 1.1 for patients receiving MDC care, compared with 1.4 hospitalizations for patients receiving SC and 1.5 hospitalizations for patients receiving NSC.

During the same period, patients receiving MDC care spent an average of 15 hours in the intensive care unit, whereas patients receiving SC spent an average of 32 hours and patients receiving NSC spent an average of 14 hours.

This trend continued through until the end of life, according to the researchers, who found that patients receiving MDC care were 33% less likely to die in a hospital than SC and NSC patients.

“The decreased risk of dying in the hospital paralleled typical quality-of-life metrics in this population, including more outpatient-based care, increased use of opioids for dyspnea management, higher use of antifibrotic therapies, and more pulmonary rehabilitations referrals,” wrote the researchers, who noted that MDC patients were 3 times more likely than SC patients to receive antifibrotic therapies, nearly twice as likely to undergo pulmonary rehabilitation, and 36% more likely to receive opiates.

Reference

Kalluri M, Lu-Song, Younus S, et al. Health care costs at the end of life for patients with idiopathic pulmonary fibrosis: evaluation of a pilot multidisciplinary collaborative interstitial lung disease clinic. Ann Am Thorac Soc. 2020;17(6):706-713. doi:10.1513/AnnalsATS.201909-707OC