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Multidisciplinary Inpatient Palliative Care Intervention

NCT ID: NCT00325611

Last Updated: 2006-05-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

550 participants

Study Classification

INTERVENTIONAL

Study Start Date

2002-04-30

Study Completion Date

2004-07-31

Brief Summary

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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.

Detailed Description

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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.

Conditions

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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

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Interventions

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Multidisciplinary palliative care team met with patient

Intervention Type BEHAVIORAL

Eligibility Criteria

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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.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Garfield Memorial Fund

OTHER

Sponsor Role collaborator

Kaiser Permanente

OTHER

Sponsor Role lead

Principal Investigators

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Ingrid M Venohr, RN, PhD

Role: STUDY_DIRECTOR

Kaiser Permanente

Douglas A Conner, PhD

Role: PRINCIPAL_INVESTIGATOR

Kaiser Permanente Northwest Region

Marcia Liberson, MSW,MPH

Role: PRINCIPAL_INVESTIGATOR

Kaiser-Permanente Northwest Region

Locations

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Kaiser Permanente of Colorado

Aurora, Colorado, United States

Site Status

Countries

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United States

References

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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.

Reference Type RESULT

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.

Reference Type RESULT

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.

Reference Type RESULT

Ryan RE, Connolly M, Bradford NK, Henderson S, Herbert A, Schonfeld L, Young J, Bothroyd JI, Henderson A. Interventions for interpersonal communication about end of life care between health practitioners and affected people. Cochrane Database Syst Rev. 2022 Jul 8;7(7):CD013116. doi: 10.1002/14651858.CD013116.pub2.

Reference Type DERIVED
PMID: 35802350 (View on PubMed)

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.

Reference Type DERIVED
PMID: 18333732 (View on PubMed)

Other Identifiers

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NW-02RRich-01

Identifier Type: -

Identifier Source: secondary_id

CO-02GGade-01 - H

Identifier Type: -

Identifier Source: org_study_id