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Background <p>Croatia has been implementing a Mobile multidisciplinary specialist palliative care team (MMSPCT), a home-based specialized palliative care service at the primary healthcare level since 2011. This study aimed to evaluate whether a MMSPCT performs better than usual care, in terms of health/well-being, experience with care, and cost outcomes.</p> Methods <p>A 3-month prospective cohort study was performed during 2017–2019. Two cohorts were compared: MMSPCT vs. usual care cohort. Sample size was based on the literature data, ranging 150–200 patients per group. A SELFIE questionnaire with selected standardised instruments was used to assess health/well-being, experience with care, and cost (on four categories: drugs, medical devices, hospitalisation for acute and chronic care), at the beginning (T0), after 1 (T1), and after 3 months (T2). Propensity score weighting using subclassification method was used to reduce selection bias by grouping exposed and control group patients into four subclasses based on similar propensity scores. The average treatment effect on the treated (ATT) was estimated using linear models with propensity score weighing and clustering based on the subclasses of propensity scores. Cost outcome variables were analysed using hurdle models due to zero-inflation in the data.</p> Results <p>410 palliative care patients were included, 220 in MMSPCT and 190 in usual care cohort; 94 patients (42.7%) vs. 124 (65.3%) completed the study at 3-months follow-up. Baseline characteristics: age, gender and number of health conditions were balanced after propensity score weighting, but not living situation, education level, marital status and smoking. After 1 and 3 months, MMSPCT patients scored significantly better on person centeredness: 0.69 (3.83%) and 1.87 (10.39%) units higher score and compassionate care: 3.33 (2.78%) and 6.14 (5.12%) points more. After 3 months, they scored significantly better on physical (4.1 points more) and emotional functioning (5.18 points more) and had significantly lower measured healthcare costs. More MMSPCT patients died at their preferred place of death (48% vs. 23%).</p> Conclusion <p>MMSPCT at primary care level may offer added value to palliative patients in Croatia and may result in a net saving in measured healthcare costs. Further clinical research is needed with a longer follow-up period and children’s cohorts.</p>

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Added value of a specialized mobile palliative care team compared to the usual care in the primary care setting of Croatia: a 3-month prospective cohort study

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  • 发表日期：

    2026年7月25日

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  • Mirjana Huić,
  • Darija Erčević,
  • Eszter Saghy,
  • Renata Grenković,
  • Romana Tandara Haček,
  • Maja Vajagić,
  • Sanja Predavec,
  • Marcell Csanádi,
  • János G. Pitter,
  • Marta Čivljak,
  • Tina Poklepović Peričić,
  • Livia Puljak,
  • Ana Utrobičić,
  • Maureen Rutten-van Mölken,
  • Antal T. Zemplényi

摘要

Background

Croatia has been implementing a Mobile multidisciplinary specialist palliative care team (MMSPCT), a home-based specialized palliative care service at the primary healthcare level since 2011. This study aimed to evaluate whether a MMSPCT performs better than usual care, in terms of health/well-being, experience with care, and cost outcomes.

Methods

A 3-month prospective cohort study was performed during 2017–2019. Two cohorts were compared: MMSPCT vs. usual care cohort. Sample size was based on the literature data, ranging 150–200 patients per group. A SELFIE questionnaire with selected standardised instruments was used to assess health/well-being, experience with care, and cost (on four categories: drugs, medical devices, hospitalisation for acute and chronic care), at the beginning (T0), after 1 (T1), and after 3 months (T2). Propensity score weighting using subclassification method was used to reduce selection bias by grouping exposed and control group patients into four subclasses based on similar propensity scores. The average treatment effect on the treated (ATT) was estimated using linear models with propensity score weighing and clustering based on the subclasses of propensity scores. Cost outcome variables were analysed using hurdle models due to zero-inflation in the data.

Results

410 palliative care patients were included, 220 in MMSPCT and 190 in usual care cohort; 94 patients (42.7%) vs. 124 (65.3%) completed the study at 3-months follow-up. Baseline characteristics: age, gender and number of health conditions were balanced after propensity score weighting, but not living situation, education level, marital status and smoking. After 1 and 3 months, MMSPCT patients scored significantly better on person centeredness: 0.69 (3.83%) and 1.87 (10.39%) units higher score and compassionate care: 3.33 (2.78%) and 6.14 (5.12%) points more. After 3 months, they scored significantly better on physical (4.1 points more) and emotional functioning (5.18 points more) and had significantly lower measured healthcare costs. More MMSPCT patients died at their preferred place of death (48% vs. 23%).

Conclusion

MMSPCT at primary care level may offer added value to palliative patients in Croatia and may result in a net saving in measured healthcare costs. Further clinical research is needed with a longer follow-up period and children’s cohorts.