Abstract
Veterans, as a distinct population, experience high rates of recidivism, with 75% of those older than 65 years having symptomatic chronic illness. Five diagnoses, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease, dementia, and cancer, account for 25% of health care visits associated with high rates of recidivism. A convenience sample of 37 veterans with advanced chronic illness from 1 rural home-based primary care clinic was evaluated. All subjects had at least 1 of the 5 listed diagnoses. One-way repeated-measures analysis of variance was used to evaluate retrospective and prospective data at 30, 60, and 90 days before/after implementation of palliative care modalities. Congestive heart failure and chronic obstructive pulmonary disease accounted for 53% of diagnoses. Sixty-five percent had 2 or more diagnoses. By day 90 after palliative management, there were 122 fewer emergency department/hospital days (P < .01) with an estimated cost avoidance of $220 000. Initiating palliative care early in the trajectory of symptomatic illness reduces recidivism and overall costs of care through management of symptoms and focusing on patient/caregiver-directed goals for improving life. Additional studies are needed to evaluate symptomatic, chronic illness for diseases outside of cancer. Education of stakeholders on the philosophy of palliative care and interdisciplinary management is vital for improved health outcomes.