Research Article
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Published Online: 11 March 2008

Impact of an Inpatient Palliative Care Team: A Randomized Controlled Trial

Publication: Journal of Palliative Medicine
Volume 11, Issue Number 2

ABSTRACT

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.

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cover image Journal of Palliative Medicine
Journal of Palliative Medicine
Volume 11Issue Number 2March 2008
Pages: 180 - 190
PubMed: 18333732

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Published online: 11 March 2008
Published in print: March 2008

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Glenn Gade
Department of Internal Medicine, Denver, Colorado.
Ingrid Venohr
Department of Senior Programs, Kaiser Permanente, Denver, Colorado.
Douglas Conner
Institute for Health Research, Kaiser Permanente, Denver, Colorado.
Kathleen McGrady
Palliative Care and Internal Medicine Permanente Medical Group, Denver, Colorado.
Jeffrey Beane
Department of Community Based Medicine, Kaiser Permanente Medical Center, San Francisco, California.
Robert H. Richardson
Palliative Care and Ethics Education, Center for Ethics in Health Care, Oregon Health and Science University, Portland, Oregon.
Marilyn P. Williams
Department of Nursing, Kaiser Foundation Hospital, San Francisco, California.
Marcia Liberson
Department of Ethics, Kaiser Foundation Hospital, Portland, Oregon.
Mark Blum
Palliative Care Service, Permanente Medical Group, Sacramento, California.
Richard Della Penna
Care Management Institute, Kaiser Permanente, Oakland, California.

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