NR-533 Week 5 Discussion: Cost-Benefit Analysis
Week 5: Cost-Benefit Analysis
Consider and restate your PICO(T) and the proposal for your final project. When you think of it as a type of new program development, w
...
NR-533 Week 5 Discussion: Cost-Benefit Analysis
Week 5: Cost-Benefit Analysis
Consider and restate your PICO(T) and the proposal for your final project. When you think of it as a type of new program development, what specific information will you need to obtain to create the cost-benefit analysis as part of your business plan for the project?
Hello class and DR. S.,
Healthcare cost increase in the last year of life due to high cost treatments. Advanced care planning (ACP) can lead to cost reduction in end of life care mostly related to decrease hospitalizations and high cost treatments and compliance with a person’s wishes. ACP can result in higher quality of life at or near death, however, cost associated with discussion intervention may lead to cost savings. (Nguyen et al., 2017)
My original PICOT question: In adults with a chronic life limiting non-cancerous illness, how does end of life discussions in comparison to no discussions affect the completion of an advanced care plan/advanced directive over a 4-6 weeks evaluation period?
P-atient-Adults with a chronic life limiting non-cancerous illness I-ntervention-End of life discussions
C-omparison-Adults without a chronic life limiting non-cancerous illness O-utcome-Completion of ACP/Advanced directive
T-ime-4-6 weeks
Cost associated with any new program needs to be projected in the business plan. This would be considered a new program/service. Specific information needed to create a cost-benefit analysis include: patient volume, revenue per patent, variable cost, fixed cost, projected visits per year, and days of operation. However, there is limited studies indicating there is a cost benefit related to this intervention. Cost reduction and savings is associated with decreased treatment and acute care hospital admission in the last year of life. (Aldridge & Kelley, 2015)
Gwen
Aldridge, M. D., & Kelley, A. S. (2015). The Myth Regarding the High Cost of End-of-Life Care. American Journal of Public Health, 105(12), 2411–2415. https://doi.org/10.2105/ajph.2015.302889
Nguyen, K.-H., Sellars, M., Agar, M., Kurrle, S., Kelly, A., & Comans, T. (2017). An economic model of advance care planning in Australia: a cost-effective way to respect patient choice. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2748-4
Sellars, M., Clayton, J. M., Detering, K. M., Tong, A., Power, D., & Morton, R. L. (2019). Costs and outcomes of advance care planning and end-of-life care for older adults with end-stage kidney disease: A person-centred decision analysis. Plos One, 14(5). https://doi.org/10.1371/journal.pone.0217787
Hello Shanna and Dr. S.,
Thank you for your input and views. I agree that end-of-life care discussions are problematic. Mostly I feel it is because the providers are not comfortable or knowledgeable about true end of life options. Many have not had prior experiences dealing with end of life issues. This is true for the community, as well as, many nurses. My facility has employed a palliative care provider within the last year. His consults has grown steady and fast. He has added another physician to assist with the consults. The medical physicians I work with have always had difficulty having or providing end of life information with the patient. Having a palliative care physician to take on the hard discussion and present the options has taken some of the burden away. Oncology specialist has the least consult. This is very surprising to me considering the population they serve. If they consult palliative care, it is very late in the treatment process. However, I feel the earlier the discussion, the more time the patient has to ensure their wishes are formalized are provided to their caregivers. I think this is a disservice to the patient robbing them of quality care and assisting them to experience a good death.
Gwen
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