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Expanding Access to Home-Based Palliative Care: A Randomized Controlled Trial Protocol.

Susan Enguidanos1, Anna Rahman1, Torrie Fields2

  • 1Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California.

Journal of Palliative Medicine
|September 6, 2019
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Home-based palliative care (HBPC) shows promise in improving patient outcomes and reducing healthcare utilization. This study evaluates an evidence-based HBPC model against usual care for seriously ill patients.

Keywords:
home-based palliative careprimary care physicianprimary palliative carerandomized controlled trial

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Area of Science:

  • Gerontology
  • Health Services Research
  • Palliative Care

Background:

  • Home-based palliative care (HBPC) is associated with improved patient outcomes and satisfaction.
  • Healthcare payment reforms facilitate the expansion of HBPC programs.
  • Evaluating the effectiveness of emerging HBPC models is crucial.

Purpose of the Study:

  • To compare an evidence-based HBPC model with enhanced usual primary care.
  • To assess the effectiveness of HBPC for seriously ill patients within integrated care systems.

Main Methods:

  • Randomized controlled trial involving 1155 seriously ill participants (heart failure, COPD, advanced cancer) and their caregivers.
  • Data collection via telephone surveys at baseline, 1, and 2 months post-enrollment, and post-bereavement for caregivers.
  • Outcome measures include patient-reported pain, symptoms, mood, hope, communication, survival, hospitalizations, and ED visits; caregiver burden, mood, and communication.

Main Results:

  • The study is ongoing, with early implementation challenges including primary care provider engagement and health plan coordination impacting enrollment.
  • Despite challenges, the study is expected to provide valuable data on the effectiveness of HBPC.

Conclusions:

  • The study aims to provide evidence supporting the adoption and widespread implementation of effective HBPC models.
  • Findings will inform healthcare providers and policymakers on the benefits of integrating palliative care into primary care settings.