Impact of an inpatient palliative care team: a randomized control trial.

Impact of an inpatient palliative care team: a randomized control trial.

Gade G; Venohr I; Conner D; McGrady K; Beane J; Richardson RH; Williams MP; Liberson M; Blum M; Della PR

Journal Of Palliative Medicine

2008

Humans; Survival Rate; Prospective Studies; Aged; Cooperative Behavior; Patient Satisfaction; DNAR; DNAR Outcomes; Quality of Life/psychology; Critical Illness/psychology; patient care team; Hospice Care/utilization; Hospitalization; Palliative Care/mt [Methods]; patient care team; Advance Directives/sn [Statistics & Numerical Data]; Advance Directives/statistics & numerical data; Critical Illness/ep [Epidemiology]; Critical Illness/epidemiology; Critical Illness/px [Psychology]; Critical Illness/rehabilitation; Critical Illness/rh [Rehabilitation]; Hospice Care/ut [Utilization]; Hospitalization/statistics & numerical data; Hospitalization/statistics & numerical data; Palliative Care/methods; Quality of Life/px [Psychology]

BACKGROUND: Palliative care improves care and reduces costs for hospitalized patients with life-limiting illnesses. There have been no multicenter randomized trials examining impact on patient satisfaction, clinical outcomes, and subsequent health care costs., OBJECTIVE: Measure the impact of an interdisciplinary palliative care service (IPCS) on patient satisfaction, clinical outcomes, and cost of care for 6 months posthospital discharge., METHODS: Multicenter, randomized, controlled trial. IPCS provided consultative, interdisciplinary, palliative care to intervention patients. Controls received usual hospital care (UC)., SETTING AND SAMPLE: Five hundred seventeen patients with life-limiting illnesses from a hospital in Denver, Portland, and San Francisco enrolled June 2002 to December 2003., MEASURES: Modified City of Hope Patient Questionnaire, total health care costs, hospice utilization, and survival., RESULTS: IPCS reported higher scores for the Care Experience scale (IPCS: 6.9 versus UC: 6.6, p = 0.04) and for the Doctors, Nurses/Other Care Providers Communication scale (IPCS: 8.3 versus UC: 7.5, p = 0.0004). IPCS patients had fewer intensive care admissions (ICU) on hospital readmission (12 versus 21, p = 0.04), and lower 6-month net cost savings of $4,855 per patient (p = 0.001). IPCS had longer median hospice stays (24 days versus 12 days, p = 0.04). There were no differences in survival or symptom control., CONCLUSIONS: IPCS patients reported greater satisfaction with their care experience and providers' communication, had fewer ICU admissions on readmission, and lower total health care costs following hospital discharge.

2008

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