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

Purpose

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.

Condition	Intervention
Pulmonary Disease Chronic Obstructive	Other: Palliative home care in advanced COPD Other: Standard of care

Study Type:	Observational
Study Design:	Observational Model: Cohort Time Perspective: Prospective
Official Title:	Community Based Self Management of COPD Facilitated by a Palliative Care Team:Impact on Health Care Utilization and QOL

Resource links provided by NLM:

MedlinePlus related topics: Palliative Care

U.S. FDA Resources

Further study details as provided by Essentia Health:

Primary Outcome Measures:

Health service utilization, symptom scores, and patient quality of life [ Time Frame: Baseline and 12 months ] [ Designated as safety issue: No ]
Health care utilization: over 12 months while enrolled on study vs. 12 months prior to enrollment. For symptom scores and quality of life: at the time of enrollment and at the end of 12 months study period.

Enrollment:	23
Study Start Date:	March 2008
Study Completion Date:	July 2009
Primary Completion Date:	July 2009 (Final data collection date for primary outcome measure)

Groups/Cohorts	Assigned Interventions
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.	Other: Palliative home care in advanced COPD 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.	Other: Standard of care Usual care for COPD patients

Eligibility

Ages Eligible for Study:	60 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No
Sampling Method:	Non-Probability Sample

Study Population

Patients with advanced COPD from St. Mary's Duluth Clinic Health Systrem population in Duluth Minnesota

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

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00648609

Locations

United States, Minnesota
Essentia Health
Duluth, Minnesota, United States, 55805

Sponsors and Collaborators

Essentia Health

Medica Sur Clinic & Foundation

Investigators

Principal Investigator:

Dean Fox, MD

Essentia Health

More Information

Publications:

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. Review.

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.

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. Review.

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. Review. No abstract available.

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. Erratum in: Am J Respir Crit Care Med 1997 Jan;155(1):386.

Responsible Party:	Dean Fox MD, St. Mary's Duluth Clinic Health System
ClinicalTrials.gov Identifier:	NCT00648609 History of Changes
Other Study ID Numbers:	080801
Study First Received:	March 27, 2008
Last Updated:	June 16, 2011
Health Authority:	United States: Institutional Review Board

Keywords provided by Essentia Health:

Community based self management of COPD with palliative care

Additional relevant MeSH terms:

Lung Diseases
Respiration Disorders
Respiratory Tract Diseases

ClinicalTrials.gov processed this record on May 16, 2013