Impact of an inpatient palliative care team: a randomized control trial.
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).


METHODS
Five hundred seventeen patients with life-limiting illnesses from a hospital in Denver, Portland, and San Francisco enrolled June 2002 to December 2003.


METHODS
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.
Gade
Glenn
G
Department of Internal Medicine, Denver, Colorado, USA. Douglas.A.Conner@KP.Org
Venohr
Ingrid
I
Conner
Douglas
D
McGrady
Kathleen
K
Beane
Jeffrey
J
Richardson
Robert H
RH
Williams
Marilyn P
MP
Liberson
Marcia
M
Blum
Mark
M
Della Penna
Richard
R
D016223:Advance Directives / Q000706:statistics & numerical data; D000368:Aged; D003299:Cooperative Behavior; D016638:Critical Illness / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D017051:Hospice Care / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D010348:Patient Care Team; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D015996:Survival Rate