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Multidisciplinary Inpatient Palliative Care Intervention

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ClinicalTrials.gov Identifier: NCT00325611
Recruitment Status : Completed
First Posted : May 15, 2006
Last Update Posted : May 15, 2006
Sponsor:
Collaborator:
Garfield Memorial Fund
Information provided by:
Kaiser Permanente

Tracking Information
First Submitted Date  ICMJE May 12, 2006
First Posted Date  ICMJE May 15, 2006
Last Update Posted Date May 15, 2006
Study Start Date  ICMJE April 2002
Primary Completion Date Not Provided
Current Primary Outcome Measures  ICMJE
 (submitted: May 12, 2006)
Quality and cost of care
Original Primary Outcome Measures  ICMJE Same as current
Change History No Changes Posted
Current Secondary Outcome Measures  ICMJE
 (submitted: May 12, 2006)
  • Greater patient satisfaction
  • Lower ICU admissions
  • Lower total costs 6 months past hospitalization
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Multidisciplinary Inpatient Palliative Care Intervention
Official Title  ICMJE A Multi-Site Replication of an Inpatient Palliative Care Program
Brief Summary 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

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.

Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Condition  ICMJE
  • 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
Intervention  ICMJE Behavioral: Multidisciplinary palliative care team met with patient
Study Arms  ICMJE Not Provided
Publications *

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Completed
Enrollment  ICMJE
 (submitted: May 12, 2006)
550
Original Enrollment  ICMJE Same as current
Study Completion Date  ICMJE July 2004
Primary Completion Date Not Provided
Eligibility Criteria  ICMJE

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.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT00325611
Other Study ID Numbers  ICMJE CO-02GGade-01 - H
NW-02RRich-01
Has Data Monitoring Committee Not Provided
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Not Provided
Study Sponsor  ICMJE Kaiser Permanente
Collaborators  ICMJE Garfield Memorial Fund
Investigators  ICMJE
Study Director: Ingrid M Venohr, RN, PhD Kaiser Permanente
Principal Investigator: Douglas A Conner, PhD Kaiser Permanente Northwest Region
Principal Investigator: Marcia Liberson, MSW,MPH Kaiser-Permanente Northwest Region
PRS Account Kaiser Permanente
Verification Date May 2006

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP