Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care.
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.
Brumley
Richard
R
Kaiser Permanente Southern California Medical Group, Downey, California, USA.
Enguidanos
Susan
S
Jamison
Paula
P
Seitz
Rae
R
Morgenstern
Nora
N
Saito
Sherry
S
McIlwane
Jan
J
Hillary
Kristine
K
Gonzalez
Jorge
J
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