Comparative effectiveness of a complex care program for high-cost/high-need Patients: A retrospective cohort study

Background: High-cost/high-need (HCHN) adults and the healthcare systems that provide their care may benefit from a new patient-centered model of care involving a dedicated physician and nurse team who coordinate both clinical and social services for a small patient panel. Objective: Evaluate the impact of a Complex Care Program (CCP) on likelihood of patient survival and hospital admission in 180 days following empanelment to the CCP. Design: Retrospective cohort study using a quasi-experimental design with CCP patients propensity score matched to a concurrent control group of eligible but unempaneled patients. Setting: Kaiser Permanente Mid-Atlantic States (KPMAS) during 2017–2018. Participants: Nine hundred twenty-nine CCP patients empaneled January 2017–June 2018, 929 matched control patients for the same period. Interventions: The KPMAS CCP is a new program consisting of 8 teams each staffed by a physician and nurse who coordinate care across a continuum of specialty care, tertiary care, and community services for a panel of 200 patients with advanced clinical disease and recent hospitalizations. Main Outcomes: Time to death and time to first hospital admission in the 180 days following empanelment or eligibility. Results: Compared to matched control patients, CCP patients had prolonged time to death (hazard ratio [HR]: 0.577, 95% CI: 0.474, 0.704), and CCP decedents had longer survival (median days 69.5 vs. 53.0, p=0.03). CCP patients had similar time to hospital admission (HR: 1.081, 95% CI: 0.930, 1.258), with similar results when adjusting for competing risk of death (HR: 1.062, 95% CI: 0.914, 1.084). Limitations: Non-randomized intervention; single healthcare system; patient eligibility limited to specific conditions. Conclusion: The KPMAS CCP was associated with significantly reduced short-term mortality risk for eligible patients who volunteered to participate in this intervention.