thebestpossiblelifenowandforthatmorningwhenshe
might wake up unable to breathe.
A two-year study of this “concurrent care” program
foundthatenrolledpatientsweremuchmorelikelytouse
hospice:thefigureleapedfrom 26 percentto 70 percent.
Thatwasnosurprise,sincetheyweren’tforcedtogiveup
anything.Thesurprisingresultwasthattheydidgiveup
things.Theyvisitedtheemergencyroomhalfasoftenas
thecontrolpatientsdid.TheiruseofhospitalsandICUs
dropped bymorethantwo-thirds.Overall costsfellby
almost a quarter.
Theresultwasstunning,andpuzzling:itwasn’tobvious
whatmadetheapproachwork.Aetnaranamoremodest
concurrent care program for a broader group of
terminallyillpatients.Forthesepatients,thetraditional
hospice rules applied—in order to qualify for home
hospice, they had to give up attempts at curative
treatment.Buteitherway,theyreceivedphonecallsfrom
palliativecarenurseswhoofferedtocheckinregularly
and help them find services for anything from pain
controltomakingoutalivingwill.Forthesepatientstoo,
hospiceenrollmentjumpedto 70 percent,andtheiruseof
hospital services dropped sharply. Among elderly
patients,useofintensivecareunitsfellbymorethan 85
percent. Satisfaction scores went way up. What was
goingonhere?Theprogram’sleadershadtheimpression
thattheyhadsimplygivenseriouslyillpatientssomeone
experienced and knowledgeable to talk to about their
daily concerns. Somehow that was enough—just talking.
The explanation would seem to strain credibility, but
evidenceforithasgrowninrecentyears.Two-thirdsof