Complex Home Care

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Nurs Econ. Author manuscript; available in PMC 2011 May 25.
Published in final edited form as: Nurs Econ. 2010 August ; 28(4): 255–264.

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Complex Home Care: Part I-Utilization and Costs to Families for Health Care Services Each Year
Ubolrat Piamjariyakul, RN, PhD[ResearchAssociate Professor], University of Kansas School of Nursing, 3901 Rainbow Boulevard, Mail Stop 4043, Kansas City, KS 66160-7502, Tel (913) 588-1544, Fax (913) 588-4531 Vicki M. Ross, RN, PhD[Research Assistant Professor], University of Kansas School of Nursing Donna Macan Yadrich, BS, MPA, CCRP[Project Coordinator], University of Kansas School of Nursing Arthur R. Williams, PhD, MA (Econ),MPA[Director], Center for Health Outcomes and Health Services Research, Children’s Mercy Hospitals and Clinics, Professor, College of Medicine University of Missouri Kansas City, Kansas City, MO Lyn Howard, MD[Professor of Gastroenterology & Nutrition], and Department of Medicine, Gastroenterology and Nutrition, Albany Medical College Carol E. Smith, RN, PhD[Professor of Nursing, Professor of PreventiveMedicine and Public Health] University of Kansas School of Nursing

Abstract
The goal of this study was to determine the annual average utilization and non-reimbursed costs of health services needed by 80 families managing lifelong complex home care. Results indicate that per patient per year there was an average of 36 appointments with a variety of health service professionals that resulted innon-reimbursed annual costs of $4,716. These costs were greater for those that were hospitalized. In follow-up articles, data collected on annual insurance premium payments and additional out-of-pocket health care costs incurred by these families are summarized (Part II) and a structural equation model of these families financial, social and emotional costs in relation to patients’ clinical outcomesand family caregivers’ quality of life is presented (Part III).

Keywords Home Parenteral Nutrition; cost; home care; health services; technology Advances in medical technology have facilitated the shift of hospital-based treatments to home settings where families manage daily complex health care regimens. As many as 120 persons per million people in the U.S. are dependent on the lifelong,complex, technologybased care of home parenteral nutrition (HPN) infusions (Bozzetti, Staun & Van Gossum, 2006). Annual reimbursement for HPN-related health services across clinical settings is approximately $2.3 billion (Kelly, 2006; Wojtylak, 2006). However, data for costs paid by families for HPN-related health care services and for non-reimbursed expenditures are rarely tabulated and most oftenunderestimated (Clabaugh & Ward, 2008).

Correspondence to: Ubolrat Piamjariyakul.

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The goals of this study were to describe health care services used by families to manage HPN, report the frequency of each service used annually. Also an estimate of the average annual non-reimbursed costs to families for these health services is calculated.

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Home Parenteral Nutrition: Background of Chronic Care Costs
Home parenteral nutrition is used to treat lifelong malnutrition from intestinal failure due to underlying chronic diseases (e.g., Crohn’s), bowel loss due to surgery or abdominal trauma, or congenital or anatomic defects (Bozetti, Staun & VanGossum, 2006). HPN therapy consists ofnutrient solutions infused over 12 to 24 hours through intravenous catheters that are surgically placed into the superior vena cava (McCloskey & McCarthy, 2007). A wide array of health care professionals provides services necessary for managing HPN at home (see Table 1). Based on Medicare/Medicaid reports, annual reimbursements (per patient) to these professionals range from $100,000 to...