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Multidisciplinary Inpatient Palliative Care Intervention

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT00325611
First Posted: May 15, 2006
Last Update Posted: May 15, 2006
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Collaborator:
Garfield Memorial Foundation
Information provided by:
Kaiser Permanente
  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: None (Open Label)
Primary Purpose: Prevention
Official Title: A Multi-Site Replication of an Inpatient Palliative Care Program

Resource links provided by NLM:


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

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
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
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): 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):
ClinicalTrials.gov Identifier: NCT00325611     History of Changes
Other Study ID Numbers: CO-02GGade-01 - H
NW-02RRich-01
First Submitted: May 12, 2006
First Posted: May 15, 2006
Last Update Posted: May 15, 2006
Last Verified: May 2006

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
Chronic Disease
Acquired Immunodeficiency Syndrome
HIV Infections
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


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