Community Based Self Management of COPD Facilitated by a Palliative Care Team:Impact on Health Care Utilization and QOL

NCT ID: NCT00648609

Last Updated: 2011-06-20

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 23 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2008-03-31
• Study Completion Date: 2009-07-31

Brief Summary

The purpose of this study is to compare in home support services for patients with COPD with usual care. The study is designed to evaluate the impact of an interdisciplinary palliative care team on community based self management of advanced COPD.

A total of thirty patients will be enrolled into this study. Twenty patients will be randomly assigned to receive usual care, and ten patients will be randomly assigned to usual care plus in home support services. This study will use objective criteria to identify patients with COPD likely to benefit from home based palliative care services. The patients will undergo initial assessment by medical, social work, and spiritual care personnel followed by a family meeting to establish a care plan. Periodic scheduled visits, and as needed unscheduled visits to address urgent needs will occur over one year's time in an attempt to return patients with COPD to the center of decision making regarding their care, avoid acute exacerbations and thereby avoid unscheduled clinic and ER visits. Patients will complete the QOL survey and symptom assessment scale upon initial intervention. After obtaining information from all patients who qualify for the study, participants will be randomized into cohorts. Those who are randomized to serve as cases will be provided with community based self management services by an interdisciplinary palliative care team. The control group will receive standard care. At the conclusion of 12 months both cases and controls will again complete the QOL survey,medical utilization, and symptom assessment.

Conditions

Pulmonary Disease Chronic Obstructive

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Home-based palliative care services

Patients who are 60 or more years of age and have a diagnosis of COPD.Patients who have received two or more unscheduled acute care visits during the 12 months prior to the start of the study.

Palliative home care in advanced COPD

Intervention Type: OTHER

Interdisciplinary palliative care team on community based self care management of advanced COPD.

Standard of care

Patients who are 60 or more years of age and have a diagnosis of COPD.Patients who have received two or more unscheduled acute care visits during the 12 months prior to the start of the study.

Standard of care

Intervention Type: OTHER

Usual care for COPD patients

Interventions

Palliative home care in advanced COPD

Interdisciplinary palliative care team on community based self care management of advanced COPD.

Intervention Type: OTHER

Standard of care

Usual care for COPD patients

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Age 60 or greater
• Dx of COPD
• Received 2 or more unscheduled acute care visits during the 12 months from Jan 2007-Dec 2007
• SMDC primary care provider
• Lives within 50 miles of Duluth Minnesota
• Informed consent

Exclusion Criteria

• Non English speaking
• Too ill or cognitively impaired to provide baseline data or informed consent
• Lives more than 50 miles from Duluth
• Nursing home resident

• Minimum Eligible Age: 60 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Medica Sur Clinic & Foundation

OTHER

Sponsor Role: collaborator

Essentia Health

OTHER

Sponsor Role: lead

Responsible Party

St. Mary's Duluth Clinic Health System

Principal Investigators

Dean Fox, MD

Role: PRINCIPAL_INVESTIGATOR

Essentia Health

Locations

Essentia Health

Duluth, Minnesota, United States

Countries

United States

References

Curtis JR, Engelberg RA, Wenrich MD, Au DH. Communication about palliative care for patients with chronic obstructive pulmonary disease. J Palliat Care. 2005 Autumn;21(3):157-64.

Reference Type: BACKGROUND

PMID: 16334970 (View on PubMed)

Halpern MT, Stanford RH, Borker R. The burden of COPD in the U.S.A.: results from the Confronting COPD survey. Respir Med. 2003 Mar;97 Suppl C:S81-9. doi: 10.1016/s0954-6111(03)80028-8.

Reference Type: BACKGROUND

PMID: 12647946 (View on PubMed)

Rocker GM, Sinuff T, Horton R, Hernandez P. Advanced chronic obstructive pulmonary disease: innovative approaches to palliation. J Palliat Med. 2007 Jun;10(3):783-97. doi: 10.1089/jpm.2007.9951.

Reference Type: BACKGROUND

PMID: 17592991 (View on PubMed)

American Academy of Hospice and Palliative Medicine; Center to Advance Palliative Care; Hospice and Palliative Nurses Association; Last Acts Partnership; National Hospice and Palliative Care Organization. National Consensus Project for Quality Palliative Care: Clinical Practice Guidelines for quality palliative care, executive summary. J Palliat Med. 2004 Oct;7(5):611-27. doi: 10.1089/jpm.2004.7.611. No abstract available.

Reference Type: BACKGROUND

PMID: 15588352 (View on PubMed)

Connors AF Jr, Dawson NV, Thomas C, Harrell FE Jr, Desbiens N, Fulkerson WJ, Kussin P, Bellamy P, Goldman L, Knaus WA. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med. 1996 Oct;154(4 Pt 1):959-67. doi: 10.1164/ajrccm.154.4.8887592.

Reference Type: BACKGROUND

PMID: 8887592 (View on PubMed)

Other Identifiers

080801

Identifier Type: -

Identifier Source: org_study_id