BACKGROUND/RATIONALE:
End-of-life treatment for patients with CHF is frequently complicated by multiple co-morbidities, accelerated functional decline, progressive symptoms, and unpredictable mortality. However, there are no existing VA studies evaluating the outcomes associated with a cardiac nurse practitioner palliative care model for CHF patients.
OBJECTIVE(S):
1.To assess whether patients with advanced CHF who are treated using the Cardiac Nurse Practitioner- Palliative Care (CNP-PC) model, compared with advanced CHF patients receiving usual CNP care, have better patient-related outcomes, in terms of: a) higher levels of health-related quality of life; b) more positive perceptions of CHF treatment; and c) improved symptom control.
2.To determine whether the use of health services resources is different among CNP-PC patients, compared with those receiving CNP-Usual Care, in terms of:
a)Greater clinician-patient continuity;
b)Differences in the timing and location of care, including fewer CHF-related inpatient admissions, hospital days of care, ICU and ER admissions, and nursing home admissions and days of care;
c)Greater use of community-centered services;
d)Greater use of palliative multidisciplinary services; and
e) Lower overall costs for VA and non-VA services, including both inpatient and outpatient services.
3.To evaluate family perceptions of the quality of palliative care for veterans with advanced CHF.
METHODS:
This study will use a randomized control design. Patients at each of the two study sites (Ann Arbor and Detroit) will be randomized to CNP-Usual Care (CNP-UC) or CNP-Palliative Care (CNP-PC) groups. Eligible patients will include those with advanced CHF, as defined by NYHA class, stage of illness, ejection fraction (EF) and other clinical criterion. We expect to enroll a total of 227 patients at the two study sites.
FINDINGS/RESULTS:
Study is ongoing; no results at this time.
IMPACT:
Interventions are needed that encourage the use of palliative care services earlier in the disease process, to provide maximum benefits from palliative-focused psychological support and symptom relief. This study is intended to direct appropriate end-of-life care to CHF patients, who have not been a traditional focus of palliative care services.
PUBLICATIONS:
Journal Articles
- Duffy SA, Copeland LA, Hopp FP, Zalenski RJ. Diagnostic classifications and resource utilization of decedents served by the Department of Veterans Affairs. Journal of Palliative Medicine. 2007; 10(5): 1137-45.
