title: Effects of a transitional palliative care model on patients with end-stage heart failure: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Heart failure (HF) is characterized by high rates of readmission after hospitalization, and readmission is a major contributor to healthcare costs. The transitional care model has proven efficacy in reducing the readmission rate and economic outcomes, and increasing satisfaction with care. However, the effectiveness of the transitional care model has not been evaluated in patients with end-stage HF. This study was designed to compare the customary hospital-based care and a comprehensive transitional care model, namely the Home-based Palliative HF Program (HPHP), in terms of readmission rate, quality of life, and satisfaction with care among end-stage HF patients under palliative care.
  
  
  METHODS
  This is a randomized controlled trial taking place in hospitals in Hong Kong. We have been recruiting patients with end-stage HF who are identified as appropriate for palliative care during hospitalization, on referral by their physicians. A set of questionnaires is collected from each participant upon discharge. Participants are randomized to receive usual care (customary hospital-based care) or the intervention (HPHP). The HPHP will be implemented for up to 12 months. Outcome measures will be performed at 1, 3, 6, and 12 months post-discharge. The primary outcome of this study is quality of life measured by the Chronic Heart Failure Questionnaire - Chinese version; secondary outcomes include readmission rate, symptom intensity, functional status, and satisfaction with care.
  
  
  CONCLUSIONS
  This study is original and will provide important information for service development in the area of palliative care. The introduction of palliative care to end-stage organ failure patients is new and has received increasing attention worldwide in the last decade. This study adopts the randomized controlled trial, a vigorous research design, to establish scientific evidence in exploring the best model for end-stage HF patients receiving palliative care.
  
  
  BACKGROUND
  This trial was registered as NCT02086305 on 7 March 2014 in the United States Clinical Trials Registration, and in the Clinical Trials Registry, Hong Kong University with the trial number UW12202.
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
authors.forename: Alina Yee Man
authors.initials: AY
authors.lastname: Ng
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China. frances.wong@polyu.edu.hk.
authors.forename: Frances Kam Yuet
authors.initials: FK
authors.lastname: Wong
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
authors.forename: Paul Hong
authors.initials: PH
authors.lastname: Lee
mesh_terms: D002985:Clinical Protocols; D003695:Delivery of Health Care; D006333:Heart Failure / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006699:Home Care Services; D006723:Hong Kong; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D010348:Patient Care Team; D010359:Patient Readmission; D017060:Patient Satisfaction; D011788:Quality of Life; D012107:Research Design; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013997:Time Factors; D000069341:Transitional Care; D016896:Treatment Outcome
keywords: End-stage heart failure; Health services utilization; Palliative care; Quality of life; Transitional care