SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 1, Issue 11 (September 6, 1996)

Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).

Introduction

Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.

Visiting Nurse Association - Los Angeles Develops Innovative Capitated System of Hospice Care

The Visiting Nurse Association - Los Angeles (VNA) has developed an innovative capitated model that emphasizes the removal of barriers to timely hospice care by AIDS patients. Emphasis is placed on the continuum of care between home health medical services and home health hospice services. Services include counseling of patients about treatment alternatives and support for physicians in regard to treatment options. Implementation of the model has resulted in improved quality of life and care as well as reduced costs for end-stage AIDS patients.

VNA's continuity of care model ensures that "transprofessionals" – hospice-trained teams of nurses and social workers assigned to each patient upon admission to care – remain with the patient through the entire treatment process, from home health medical services to hospice care. To assess its efficacy, the VNA model was compared to a more traditional home health care model. The more traditional model differs in two significant ways: (1) home health nurses do not have hospice experience, and (2) continuity of care is disrupted when patients transition from home health to hospice care as health care providers change. Patient costs per unit of service in both systems were compared, as were quality of life and care and disease-specific biopsychological data. Participants in the study were Los Angeles County AIDS patients requiring home care.

The VNA continuum of care model clearly produces lower costs throughout the entire episode of care. For every dollar expended on continuum of care model patients, the cost expended for patients in the more traditional care program was 59 cents greater ($1.00 compared to $1.59).

The significant cost savings in the continuum of care model present significant policy implications for the future of end-stage services for HIV/AIDS patients specifically, and perhaps for terminal chronic care in general. Introducing a blended model of care into the mainstream of terminal care may have significant effects in reducing costs, and may be critical in the development of a replicable, capitated community-based model of care. By altering slightly the care team to address biopsychosocial issues, the profile of service delivery is substantially changed.

Perhaps even more importantly, study results indicate that the VNA continuum of care model enhances the ability of AIDS patients to receive the full benefits of hospice care. As patients survive for longer periods of time, both the curative and palliative hospice services intrinsic to the VNA model become more critical to quality of care and end-stage quality of life.

Presentation: The Transprofessional Model of Care for HIV/AIDS: An Evaluation of the Model [PDF / View as HTML]

For more information, contact David Cherin, Ph.D., Visiting Nurse Foundation of Los Angeles, 101 S. First Street #407, Burbank, CA 91502, 818.526.1780.

SPNS/Fax is produced by The Measurement Group–PROTOTYPES Evaluation and Dissemination Center (EDC). Editorial comments should be made to The Measurement Group at 5811A Uplander Way, Culver City, California 90230, 310.216.1051, 310.670.7735 (fax).
 

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