Home-based palliative care services for underserved populations.
BACKGROUND
Kokua Kalihi Valley is one of the first federally qualified community health centers offering home-based palliative care (HBPC). Kokua Kalihi Valley serves low-income, immigrant populations from Asia and the Pacific Islands, whose end-of-life needs are rarely addressed. Our team includes a palliative medicine physician, nurse, case manager, psychologist, interpreter, and volunteers.


OBJECTIVE
The purpose of this Institutional Review Board-approved study was to measure symptom relief and quality of life, resource utilization, and satisfaction with HBPC.


METHODS
Over 12 months, 91 people including 46 patients with chronic advanced illnesses and 45 corresponding primary caregivers were enrolled. Data were collected prospectively, upon admission, and repeatedly thereafter, using the Missoula-Vitas Quality of Life Index, the Edmonton Symptom Assessment Scale, and the Palliative Performance Scale. Utilization of resources was tracked, including case management, hospice, emergency department, and hospital visits.


RESULTS
The median age was 71 years, and more than half had chronic neurodegenerative conditions. Most patients (98%) were minority, including Samoans, Filipinos, Japanese, Micronesians, and Hawaiians. Median stay in HBPC was 7 months, with a median of 3.5 visits. Approximately 25% of patients enrolled in hospice (median stay 67.5 days). There was a decrease in hospitalizations (p = 0.002) after HBPC admission. Discussions and documentation of end-of-life wishes increased from 50% to 90% (p < 0.01). Caregiver satisfaction with HBPC was high.


CONCLUSIONS
Data on outcomes and quality indicators of HBPC programs are scant, especially among immigrant Asian and Pacific Islanders patients. Our experience demonstrates the effectiveness of palliative care approaches in this population.
Division of Palliative Medicine, Department of Geriatric Medicine, University of Hawaii, Honolulu, Hawaii 96817, USA. fernandes.ritabelle@gmail.com
Ritabelle
R
Fernandes
Kathryn L
KL
Braun
Joseph
J
Ozawa
Merlita
M
Compton
Crisanta
C
Guzman
Emese
E
Somogyi-Zalud
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian; D054242:Emigrants and Immigrants; D005260:Female; D006254:Hawaii; D019538:Health Care Surveys; D006305:Health Status Indicators; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander; D010166:Palliative Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D011788:Quality of Life