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Healthcare use and out-of-pocket costs for rural family caregivers and care recipients in a randomized controlled trial.

Publication ,  Journal Article
Kaufman, BG; Huang, RW; Holland, DE; Vanderboom, CE; Ingram, C; Wild, EM; Dose, AM; Stiles, C; Gustavson, AM; Mandrekar, J; Van Houtven, CH ...
Published in: J Am Geriatr Soc
May 2, 2024

BACKGROUND: Rural family caregivers (FCGs) in the United States often experience high economic costs. This randomized controlled trial compared a transitional palliative care intervention (TPC) to support FCGs of seriously ill care recipients (CRs) to an attention control condition. We evaluated the TPC's effect on healthcare use and out-of-pocket spending for both FCGs and CRs. METHODS: TPC FCGs received teaching, guidance, and counseling via video calls for 8 weeks following CR discharge from the hospital. After discharge, a research assistant called all FCGs once a month for up to 6 months or CR death to collect self-reported healthcare utilization (e.g., outpatient, emergency department, and hospital), out-of-pocket healthcare spending (e.g., deductibles and coinsurance), and health-related travel costs (e.g., transportation, lodging, food) for FCGs and CRs. Incidence rate ratios (IRRs) were estimated using negative binomial regressions. RESULTS: The study included 282 FCG-CR dyads across three U.S. states. Follow-up over the 6-month period was shortened by high CR mortality rates across both arms (29%), but was similar across arms. TPC reduced nights in the hospital for CR (IRR = 0.75; 95% confidence interval [CI] = 0.56-0. 99). Total out-of-pocket spending was not significantly different for TPC versus control. Across both groups, mean out-of-pocket spending for dyads was $1401.85, with healthcare payments contributing $1048.58 and transportation expenses contributing $136.79. TPC dyads reported lower lodging costs (IRR = 0.71; 95% CI = 0.56-0.89). CONCLUSIONS: This study contributes to evidence that palliative care interventions reduce the number of nights in the hospital for seriously ill patients. Yet, overall rural FCGs and seriously ill CRs experience substantial out-of-pocket economic costs in the 6 months following hospitalization. Transitional care intervention design should consider impacts on patient and caregiver spending. CLINICALTRIALS: gov # is NCT03339271.

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Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

May 2, 2024

Location

United States

Related Subject Headings

  • Geriatrics
  • 52 Psychology
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
  • 11 Medical and Health Sciences
 

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Kaufman, B. G., Huang, R. W., Holland, D. E., Vanderboom, C. E., Ingram, C., Wild, E. M., … Griffin, J. M. (2024). Healthcare use and out-of-pocket costs for rural family caregivers and care recipients in a randomized controlled trial. J Am Geriatr Soc. https://doi.org/10.1111/jgs.18934
Kaufman, Brystana G., Ro W. Huang, Diane E. Holland, Catherine E. Vanderboom, Cory Ingram, Ellen M. Wild, Ann Marie Dose, et al. “Healthcare use and out-of-pocket costs for rural family caregivers and care recipients in a randomized controlled trial.J Am Geriatr Soc, May 2, 2024. https://doi.org/10.1111/jgs.18934.
Kaufman BG, Huang RW, Holland DE, Vanderboom CE, Ingram C, Wild EM, et al. Healthcare use and out-of-pocket costs for rural family caregivers and care recipients in a randomized controlled trial. J Am Geriatr Soc. 2024 May 2;
Kaufman, Brystana G., et al. “Healthcare use and out-of-pocket costs for rural family caregivers and care recipients in a randomized controlled trial.J Am Geriatr Soc, May 2024. Pubmed, doi:10.1111/jgs.18934.
Kaufman BG, Huang RW, Holland DE, Vanderboom CE, Ingram C, Wild EM, Dose AM, Stiles C, Gustavson AM, Mandrekar J, Van Houtven CH, Griffin JM. Healthcare use and out-of-pocket costs for rural family caregivers and care recipients in a randomized controlled trial. J Am Geriatr Soc. 2024 May 2;
Journal cover image

Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

May 2, 2024

Location

United States

Related Subject Headings

  • Geriatrics
  • 52 Psychology
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
  • 11 Medical and Health Sciences