Palliative Care in Patients With COVID-19: Analysis of Costs of Hospitalization in Wards and Intensive Care Units

NCT ID: NCT05897229

Last Updated: 2023-06-15

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

NOT_YET_RECRUITING

Total Enrollment

200 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-10-01

Study Completion Date

2026-10-01

Brief Summary

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The confrontation of COVID-19 foreshadowed a serious crisis of scarce health resources worldwide. To assist in this confrontation, the Palliative Care Scientific Technical Core of the Clinical Hospital, School of Medicine, Sao Paulo University (USP) elaborated a Triage Protocol for Palliative Care (PALI-COVID Tool) and it was possible to categorize the patients in three groups, according to the risk of death and needs of Palliative Care (PC), through the clinical evaluation of the patient that also directed them to the hospitalization resource according to their need (ward x ICU).

Detailed Description

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The patients grouped as with higher risk of death and PC needs (green group) by PALI-COVID Tool were those with a profile of end-of-life, signs of clinical deterioration and risk of death on admission and thus indicated for admission to the COVID-19 Palliative Care Inpatient Unit, however some were admitted to the ICU. Objective: to analyze the direct costs of hospitalization of COVID-19 Palliative Care patients in Palliative Care Inpatient Unit and ICU screened as green group by the COVID-19 Screening Protocol developed in the institution. Methods: observational, cross-sectional and retrospective study of the service database of patients over 18 years of age screened as the green group (PALI-COVID). The variables to be investigated are related to sociodemographic and clinical data, length of stay and hospitalization scenarios, time to call for PC, outcome and costs.

Conditions

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COVID-19 Palliative Care

Study Design

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Observational Model Type

COHORT

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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PC - end-stage disease criteria and high risk of death from the disease prior to COVID-19

Patients with severe forms of COVID-19 (RT-PCR+) admitted to a high-complexity hospital.

Of these, patients with end-stage disease criteria and high risk of death from the disease prior to COVID-19 were admitted, at clinical criteria, to palliative care unit.

If there are patients who received both types of treatment, this group will also be analyzed.

Analysis of costs with patient care during hospitalization

Intervention Type OTHER

Analysis of direct costs with supplies, medications, diets, laboratory tests and imaging exams, and invasive procedures such as mechanical ventilation, dialysis, and the use of vasoactive drugs.-analysis of costs referring to working hours of physicians, nurses and physical therapists in each unit normalized for the same number of beds.- cost minimization and consequential cost analysis.

ICU - end-stage disease criteria and high risk of death from the disease prior to COVID-19

Patients with severe forms of COVID-19 (RT-PCR+) admitted to a high-complexity hospital.

Of these, patients with end-stage disease criteria and high risk of death from the disease prior to COVID-19 were admitted, at clinical criteria, to the ICU.

If there are patients who received both types of treatment, this group will also be analyzed.

Analysis of costs with patient care during hospitalization

Intervention Type OTHER

Analysis of direct costs with supplies, medications, diets, laboratory tests and imaging exams, and invasive procedures such as mechanical ventilation, dialysis, and the use of vasoactive drugs.-analysis of costs referring to working hours of physicians, nurses and physical therapists in each unit normalized for the same number of beds.- cost minimization and consequential cost analysis.

PC & ICU - end-stage disease criteria and high risk of death from the disease prior to COVID-19

Patients with severe forms of COVID-19 (RT-PCR+) admitted to a high-complexity hospital.

Of these, patients with end-stage disease criteria and high risk of death from the disease prior to COVID-19 were admitted, at clinical criteria, to the ICU and palliative care unit.

If there are patients who received both types of treatment, this group will also be analyzed.

Analysis of costs with patient care during hospitalization

Intervention Type OTHER

Analysis of direct costs with supplies, medications, diets, laboratory tests and imaging exams, and invasive procedures such as mechanical ventilation, dialysis, and the use of vasoactive drugs.-analysis of costs referring to working hours of physicians, nurses and physical therapists in each unit normalized for the same number of beds.- cost minimization and consequential cost analysis.

Interventions

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Analysis of costs with patient care during hospitalization

Analysis of direct costs with supplies, medications, diets, laboratory tests and imaging exams, and invasive procedures such as mechanical ventilation, dialysis, and the use of vasoactive drugs.-analysis of costs referring to working hours of physicians, nurses and physical therapists in each unit normalized for the same number of beds.- cost minimization and consequential cost analysis.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* inpatients with severe forms of COVID-19 between April 08 and July 31, 2020
* positive reverse-transcriptase polymerase chain reaction (RT-PCR).
* patients with terminal illness and high clinical risk of death before COVID-19.
* those admitted to an ICU or palliative care unit.

Exclusion Criteria

* absence of hospitalization cost data in the institution's electronic records
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Sao Paulo General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Ricardo Tavares de Carvalho

Collaborator Professor, Palliative Care Departament Coordinator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ricardo T de Carvalho, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Sao Paulo General Hospital

Central Contacts

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Maria DC Otero Rodriguez, BSc

Role: CONTACT

+ 55 11 2661-2407

Ednalda M Franck, RN, MSc

Role: CONTACT

+ 55 11 99814-6580

References

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Anagusko SS, Rosa IB, Angelo MFF. Fundamentos dos Cuidados Paliativos aplicados à pandemia. In: Daniel Battacini Dei Santi, Luciana Suely Barros Cavalcante, Ednalda Maria Franck,Ricardo Tavares de Carvalho. (Org.). Cuidados Paliativos na Prática Clínica em Tempos de COVID-19. 1ed.Rio de Janeiro: Atheneu, 2021, v. 1, p. 5-15.

Reference Type BACKGROUND

Carvalho RT, Crispim DH, Franck EM, Dei Santi DB, Anagusko SS, Fukuda MV, Cavalcante LSB, Jales SMDCP, Queiroz MEG, Bonfa ESDO. Palliative care in the COVID-19 pandemic: Strategy of HCFMUSP. Clinics (Sao Paulo). 2022 Jan-Dec;77:100050. doi: 10.1016/j.clinsp.2022.100050. Epub 2022 May 17. No abstract available.

Reference Type BACKGROUND
PMID: 35662009 (View on PubMed)

Downar J, Seccareccia D; Associated Medical Services Inc. Educational Fellows in Care at the End of Life. Palliating a pandemic: "all patients must be cared for". J Pain Symptom Manage. 2010 Feb;39(2):291-5. doi: 10.1016/j.jpainsymman.2009.11.241.

Reference Type BACKGROUND
PMID: 20152591 (View on PubMed)

Fadul N, Elsayem AF, Bruera E. Integration of palliative care into COVID-19 pandemic planning. BMJ Support Palliat Care. 2021 Mar;11(1):40-44. doi: 10.1136/bmjspcare-2020-002364. Epub 2020 Jun 11.

Reference Type BACKGROUND
PMID: 32527790 (View on PubMed)

Franck EM, Jales SMCP, Dei Santi DB, Cavalcante LSB, Silva MLF. A equipe multiprofissional na pandemia: novas formas de atuação, antigos desafios. In: Daniel Battacini Dei Santi, Luciana Suely Barros Cavalcante, Ednalda Maria Franck, Ricardo Tavares de Carvalho. (Org.). Cuidados Paliativos na Prática Clínica em Tempos de COVID-19. 1ed.Rio de Janeiro: Atheneu, 2021, v. 1, p. 31-44.

Reference Type BACKGROUND

May P, Normand C, Cassel JB, Del Fabbro E, Fine RL, Menz R, Morrison CA, Penrod JD, Robinson C, Morrison RS. Economics of Palliative Care for Hospitalized Adults With Serious Illness: A Meta-analysis. JAMA Intern Med. 2018 Jun 1;178(6):820-829. doi: 10.1001/jamainternmed.2018.0750.

Reference Type BACKGROUND
PMID: 29710177 (View on PubMed)

Medical guidelines for determining prognosis in selected non-cancer diseases. The National Hospice Organization. Hosp J. 1996;11(2):47-63. doi: 10.1080/0742-969x.1996.11882820. No abstract available.

Reference Type BACKGROUND
PMID: 8949013 (View on PubMed)

Sheridan PE, LeBrett WG, Triplett DP, Roeland EJ, Bruggeman AR, Yeung HN, Murphy JD. Cost Savings Associated With Palliative Care Among Older Adults With Advanced Cancer. Am J Hosp Palliat Care. 2021 Oct;38(10):1250-1257. doi: 10.1177/1049909120986800. Epub 2021 Jan 11.

Reference Type BACKGROUND
PMID: 33423523 (View on PubMed)

Related Links

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http://www.planalto.gov.br/ccivil_03/_ato2015-2018/2018/lei/l13709.htm

Brazil.Law No. 13.709 General Law for the Protection of Personal Data (LGPD). 2018.

http://www.in.gov.br/en/web/dou/-/lei-n-13.979-de-6-de-fevereiro-de-2020-242078735

Brazil. Law No. 13,979 provides for the measures for dealing with the public health emergency of international importance resulting from the coronavirus responsible for the public health outbreak of international importance resulting from the coronavirus

http://www.thewhpca.org/resources/category/building-integrated-palliative-care-programs-and-services

World Health Organization(WHO).Building integrated Palliative Care programs and services.2017

http://ourworldindata.org/covid-deaths

Oxford University.Our world in data: coronavirus (COVID-19) data. 2020

http://www.who.int/publications/i/item/9789241514460

WHO.Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises: a WHO guide. 2022

Other Identifiers

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31385420.6.1001.0068

Identifier Type: -

Identifier Source: org_study_id

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