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Completed

NCT Number: NCT00325611

Multidisciplinary Inpatient Palliative Care Intervention

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.

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Key information

Conditions

Cerebrovascular Accident Acquired Immunodeficiency Syndrome Arterial Occlusive Diseases Arteriosclerosis Blood-Borne Infections Brain Diseases Cancer Cardiovascular Diseases Central Nervous System Diseases Cerebrovascular Disorders Chronic Disease Communicable Diseases Coronary Arteriosclerosis Coronary Artery Disease Coronary Disease Dementia Diabetes Mellitus Digestive System Diseases Disease Attributes Endocrine System Diseases Failure to Thrive Female Urogenital Diseases Female Urogenital Diseases and Pregnancy Complications Genital Diseases Glucose Metabolism Disorders HIV Infections Heart Diseases Heart Failure Heart Failure, Congestive Hepatic Insufficiency Immune System Diseases Immunologic Deficiency Syndromes Infections Kidney Diseases Kidney Failure, Chronic Lentivirus Infections Liver Diseases Liver Failure Lung Diseases Lung Diseases, Obstructive Male Urogenital Diseases Mental Disorders Metabolic Diseases Myocardial Ischemia Neoplasms Nervous System Diseases Neurocognitive Disorders Nutritional and Metabolic Diseases Pathologic Processes Pathological Conditions, Signs and Symptoms Pneumonia Pulmonary Disease, Chronic Obstructive RNA Virus Infections Renal Failure Renal Insufficiency Renal Insufficiency, Chronic Respiration Disorders Respiratory Failure Respiratory Insufficiency Respiratory Tract Diseases Respiratory Tract Infections Retroviridae Infections Sexually Transmitted Diseases Sexually Transmitted Diseases, Viral Signs and Symptoms Slow Virus Diseases Stroke Urogenital Diseases Urologic Diseases Vascular Diseases Virus Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Kaiser Permanente of Colorado

Aurora, Colorado, 80014, United States

About this study

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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

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.

Treatment and study plan

Multidisciplinary palliative care team met with patient

Behavioral

Primary outcomes

  1. Quality and cost of care

Secondary outcomes

  1. Greater patient satisfaction

  2. Lower ICU admissions

  3. Lower total costs 6 months past hospitalization

Sponsors and collaborators

Lead sponsor

Kaiser Permanente

Other

Collaborators

  • Garfield Memorial Fund

Registry information

Official study title

A Multi-Site Replication of an Inpatient Palliative Care Program

Important dates

Study start
2002
Study completion
2004
First posted
May 15, 2006
Registry last updated
May 15, 2006

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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