Process and Cost Evaluation of a Successful Palliative Telecare Team Intervention in Heart and Lung Disease.

Abstract

In a multisite randomized clinical trial, a nurse and social worker telecare team intervention (ADAPT) improved quality of life, disease-specific health status, depression, and anxiety among high-risk patients with chronic obstructive pulmonary disease, heart failure, or interstitial lung disease. Examine the content, processes, and cost of delivering the ADAPT intervention. Analysis of prospectively collected data from the ADAPT randomized clinical trial, including intervention session frequency/duration, team recommendations, and per-patient cost to deliver the intervention using time-driven activity-based costing. Mean length of the intervention was 115.1 (SD 33.4) days. Participants (n = 153) averaged 10.0 (SD 3.3) sessions with the nurse and 9.5 (SD 3.4) sessions with the social worker; 80.4% completed all required social work sessions and all required nurse sessions. The team discussed each participant an average of 3.7 (SD 1.8) times and made 7 (SD 3.8) recommendations per participant. Common recommendations included referrals/consults (79.7%, e.g., mental health, sleep, PT/OT, other specialists), medication additions (58.1%) or changes (31.8%), and tests (33.1%). The mean cost to implement and deliver the intervention per patient was $1139.68 (SD $368.15). In a successful nurse and social work telecare team intervention, there was high participation in nurse and social worker sessions, individualized medical and behavioral interventions, and connecting of participants to existing medical and community resources. The intervention produced clinically meaningful changes in multiple quality of life outcomes for a relatively low cost.