title: Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care.
abstract: OBJECTIVE
  To determine whether an in-home palliative care intervention for terminally ill patients can improve patient satisfaction, reduce medical care costs, and increase the proportion of patients dying at home.
  
  
  METHODS
  A randomized, controlled trial.
  
  
  METHODS
  Two health maintenance organizations in two states.
  
  
  METHODS
  Homebound, terminally ill patients (N=298) with a prognosis of approximately 1 year or less to live plus one or more hospital or emergency department visits in the previous 12 months.
  
  
  METHODS
  Usual versus in-home palliative care plus usual care delivered by an interdisciplinary team providing pain and symptom relief, patient and family education and training, and an array of medical and social support services.
  
  
  METHODS
  Measured outcomes were satisfaction with care, use of medical services, site of death, and costs of care.
  
  
  RESULTS
  Patients randomized to in-home palliative care reported greater improvement in satisfaction with care at 30 and 90 days after enrollment (P<.05) and were more likely to die at home than those receiving usual care (P<.001). In addition, in-home palliative care subjects were less likely to visit the emergency department (P=.01) or be admitted to the hospital than those receiving usual care (P<.001), resulting in significantly lower costs of care for intervention patients (P=.03).
  
  
  CONCLUSIONS
  In-home palliative care significantly increased patient satisfaction while reducing use of medical services and costs of medical care at the end of life. This study, although modest in scope, presents strong evidence for reforming end-of-life care.
authors.affiliation: Kaiser Permanente Southern California Medical Group, Downey, California, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Brumley
authors.forename: Susan
authors.initials: S
authors.lastname: Enguidanos
authors.forename: Paula
authors.initials: P
authors.lastname: Jamison
authors.forename: Rae
authors.initials: R
authors.lastname: Seitz
authors.forename: Nora
authors.initials: N
authors.lastname: Morgenstern
authors.forename: Sherry
authors.initials: S
authors.lastname: Saito
authors.forename: Jan
authors.initials: J
authors.lastname: McIlwane
authors.forename: Kristine
authors.initials: K
authors.lastname: Hillary
authors.forename: Jorge
authors.initials: J
authors.lastname: Gonzalez
mesh_terms: D000368:Aged; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006279:Health Maintenance Organizations / Q000191:economics*; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011379:Prognosis; D012189:Retrospective Studies; D019452:Terminally Ill