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Sponsors and Collaborators: |
Kaiser Permanente Garfield Memorial Foundation |
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Information provided by: | Kaiser Permanente |
ClinicalTrials.gov Identifier: | NCT00325611 |
Palliative care is believed to improve care of patients with life-limiting illnesses. This study evaluated the impact of a multi-center randomized trial of a palliative care team intervention on the quality and cost of care of hospitalized patients. Study subjects were randomized to intervention or usual care. At study end, patients receiving the palliative care intervention reported greater patient satisfaction with their care. Intervention patients also had significantly fewer ICU admissions and lower total costs for care 6 months past their hospitalization. Intervention patients completed more advance directives and had longer hospice stays.
Condition | Intervention |
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Cerebrovascular Accident Cancer Coronary Arteriosclerosis Heart Failure, Congestive Diabetes Mellitus Acquired Immunodeficiency Syndrome Failure to Thrive Pulmonary Disease, Chronic Obstructive Dementia Kidney Failure, Chronic Pneumonia Liver Failure Renal Failure Respiratory Failure Stroke |
Behavioral: Multidisciplinary palliative care team met with patient |
Study Type: | Interventional |
Study Design: | Prevention, Randomized, Open Label, Placebo Control, Single Group Assignment |
Official Title: | A Multi-Site Replication of an Inpatient Palliative Care Program |
Estimated Enrollment: | 550 |
Study Start Date: | April 2002 |
Estimated Study Completion Date: | July 2004 |
The Inpatient Palliative Care Service (IPCS) was implemented at three Kaiser-Permanente sites: Colorado, Portland and San Francisco. The service consisted of a physician, nurse, social worker, and spiritual counselor who worked with the study subjects randomized to receive the intervention. The intervention included symptom control, emotional and spiritual support, advance care and post-discharge care planning, There were no differences in symptom control or emotional support but IPCS patient reported better spiritual support compared to usual care patients. IPCS patients also reported greater satisfaction with their hospital care experience and better communication with their providers. Both IPCS and usual care patients reported improved quality of life during their enrollment hospital stay. IPCS patients completed more advance directives.
IPCS patients had more home health visits than usual care patients but significantly fewer ICU admissions. IPCS patients had significantly lower hospital costs and higher pharmacy costs, than the usual care patients. IPCS patients had significantly lower (p= .001) total health services costs (a cost savings of $64.90 per patient per day) compared to usual care patients. This translated to an average total cost savings of $3,185 per enrolled patient. IPCS patients had a significantly longer average hospice length of stay. There were no differences between IPC and usual care patients in the proportion admitted to hospice, time to hospice admission, the average length of survival, or proportion of those who survived to 6 months. Conclusion: IPCS resulted in better spiritual support, a better hospital care experience, better communication with their providers, increased completion of advance directives, fewer ICU admissions, longer hospice stays and reduced overall health care costs.
Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Adults 18 years and older
Exclusion Criteria:
United States, Colorado | |
Kaiser Permanente of Colorado | |
Aurora, Colorado, United States, 80014 |
Study Director: | Ingrid M Venohr, RN, PhD | Kaiser Permanente |
Principal Investigator: | Douglas A Conner, PhD | Kaiser Permanente Northwest Region |
Principal Investigator: | Marcia Liberson, MSW,MPH | Kaiser-Permanente Northwest Region |
Study ID Numbers: | CO-02GGade-01 - H, NW-02RRich-01 |
Study First Received: | May 12, 2006 |
Last Updated: | May 12, 2006 |
ClinicalTrials.gov Identifier: | NCT00325611 History of Changes |
Health Authority: | United States: Institutional Review Board |
Palliative care End of life care |
Liver Diseases Cerebral Infarction Arteriosclerosis Brain Diseases Respiratory Insufficiency Kidney Diseases Metabolic Disorder Delirium Arterial Occlusive Diseases Heart Diseases Metabolic Diseases Respiration Disorders Acquired Immunodeficiency Syndrome Endocrine System Diseases Ischemia |
Cognition Disorders Virus Diseases Delirium, Dementia, Amnestic, Cognitive Disorders HIV Infections Lung Diseases Growth Disorders Infarction Pneumonia Sexually Transmitted Diseases, Viral Renal Insufficiency Myocardial Ischemia Kidney Failure, Chronic Cerebrovascular Disorders Lung Diseases, Obstructive Urologic Diseases |
Liver Diseases Slow Virus Diseases Cerebral Infarction Arteriosclerosis Brain Diseases Respiratory Insufficiency Pathologic Processes Cardiovascular Diseases Kidney Diseases Arterial Occlusive Diseases Heart Diseases Metabolic Diseases Immune System Diseases Respiration Disorders Nervous System Diseases |
Acquired Immunodeficiency Syndrome Endocrine System Diseases Virus Diseases Delirium, Dementia, Amnestic, Cognitive Disorders HIV Infections Lung Diseases Growth Disorders Pneumonia Sexually Transmitted Diseases, Viral Disease Attributes Renal Insufficiency Myocardial Ischemia Kidney Failure, Chronic Cerebrovascular Disorders Lung Diseases, Obstructive |