Multidisciplinary Inpatient Palliative Care Intervention - Full Text View

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

Resource links provided by NLM:

MedlinePlus related topics: HIV/AIDS Palliative Care

U.S. FDA Resources

Further study details as provided by Kaiser Permanente:

Primary Outcome Measures:

Quality and cost of care

Secondary Outcome Measures:

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

Detailed Description:

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 (Adult, Senior)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

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

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00325611

Locations


United States, Colorado
Kaiser Permanente of Colorado
Aurora, Colorado, United States, 80014

Sponsors and Collaborators

Kaiser Permanente

Garfield Memorial Foundation

Investigators


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:

Conner D. Differences in survival, hospice admission, and hospice length of stay for patients randomized to either an inpatient palliative care team intervention or to usual care. Poster presentation at the American Geriatrics Society Annual Meeting. May 2005.

Conner D, McGrady K, Richardson R, Beane J. Predictors of Hospice Admission and Length of Stay from a Randomized Control Trial of an Inpatient Palliative Care Service. Paper presentation at the American Academy of Hospice and Palliative Medicine annual meeting. February 2006, Nashville, TN.

McGrady K, Conner D, Richardson R, Beane J, Connors L, Rastrelli A, Collins T. Influence of an Inpatient Palliative Care Team on Service Utilization and Costs. Paper presentation at the American Academy of Hospice and Palliative Medicine annual meeting. February 2006, Nashville, TN.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Gade G, Venohr I, Conner D, McGrady K, Beane J, Richardson RH, Williams MP, Liberson M, Blum M, Della Penna R. Impact of an inpatient palliative care team: a randomized control trial. J Palliat Med. 2008 Mar;11(2):180-90. doi: 10.1089/jpm.2007.0055.


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:


Diabetes Mellitus Heart Failure Lung Diseases Pneumonia Dementia Immunologic Deficiency Syndromes Renal Insufficiency Respiratory Insufficiency Acquired Immunodeficiency Syndrome HIV Infections Chronic Disease Pulmonary Disease, Chronic Obstructive Stroke Liver Failure Arteriosclerosis	Kidney Failure, Chronic Coronary Artery Disease Myocardial Ischemia Failure to Thrive Glucose Metabolism Disorders Metabolic Diseases Endocrine System Diseases Heart Diseases Cardiovascular Diseases Respiratory Tract Diseases Respiratory Tract Infections Brain Diseases Central Nervous System Diseases Nervous System Diseases Neurocognitive Disorders

ClinicalTrials.gov processed this record on September 23, 2016