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Cost-effectiveness of Veterans Administration Hospital-Based Home Care A Randomized Clinical Trial

Joan E. Cummings, MD; Susan L. Hughes, DSW; Frances M. Weaver, PhD; Larry M. Manheim, PhD; Kendon J. Conrad, PhD; Karen Nash, MA; Barbara Braun, PhD; Jill Adelman, RN
Arch Intern Med. 1990;150(6):1274-1280. doi:10.1001/archinte.1990.00390180092017.
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• A randomized design was used to examine the cost-effectiveness of a Veterans Administration hospital-based home care program that case managed inpatient and outpatient care. Patients (N=419) with two or more functional impairments or a terminal illness were randomized to hospital-based home care (n=211) or customary care (n=208). Functional status, satisfaction with care, and morale were measured at baseline and at 1 and 6 months after discharge from the hospital; health care utilization was tracked for 6 months. Findings included significantly higher (0.1 on a three-point scale) patient and caregiver satisfaction with care at 1 month and lower Veterans Administration and private sector hospital costs ($3000 vs $4245) for the experimental group. Net per person health care costs were also 13% lower in the experimental group. We conclude that this model of hospital-based home care is cost-effective and that its expansion to cover these two patient groups throughout the Veterans Administration system can improve patient care at no additional cost.

(Arch Intern Med. 1990;150:1274-1280)


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