Multidisciplinary Inpatient Palliative Care Intervention
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Purpose
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 |
|---|---|
|
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: | Allocation: Randomized Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Prevention |
| Official Title: | A Multi-Site Replication of an Inpatient Palliative Care Program |
- Quality and cost of care
- Greater patient satisfaction
- Lower ICU admissions
- Lower total costs 6 months past hospitalization
| 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.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Adults 18 years and older
-admitted to acute inpatient care who had: (1) a medical diagnosis which was life-threatening, and (2) whose attending physician indicated they “would not be surprised if the patient died within one year”.
Exclusion Criteria:
- 1) they had impaired cognitive status and no caregiver was available to provide consent, (2) were currently enrolled in hospice or other studies involving palliative care, (3) the attending physician did not approve study participation, or (4) their medical condition impaired participation (actively dying, too ill to participate) and no family member was available to provide consent.
Contacts and Locations| 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 |
More Information
Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| ClinicalTrials.gov Identifier: | NCT00325611 History of Changes |
| Other Study ID Numbers: | CO-02GGade-01 - H, NW-02RRich-01 |
| Study First Received: | May 12, 2006 |
| Last Updated: | May 12, 2006 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Kaiser Permanente:
|
Palliative care End of life care |
Additional relevant MeSH terms:
|
Acquired Immunodeficiency Syndrome HIV Infections Arteriosclerosis Chronic Disease Coronary Artery Disease Myocardial Ischemia Dementia Diabetes Mellitus Failure to Thrive Heart Failure Immunologic Deficiency Syndromes Kidney Failure, Chronic Lung Diseases Respiration Disorders Pulmonary Disease, Chronic Obstructive |
Pneumonia Renal Insufficiency Cerebral Infarction Stroke Liver Failure Respiratory Insufficiency Lentivirus Infections Retroviridae Infections RNA Virus Infections Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Slow Virus Diseases Immune System Diseases Arterial Occlusive Diseases |
ClinicalTrials.gov processed this record on February 26, 2013
