Improving palliative care through teamwork (IMPACTT) in nursing homes: Study design and baseline findings.
The 2014 Institute of Medicine report recommended that healthcare providers caring for individuals with advanced illness have basic palliative care competencies in communication, inter-professional collaboration, and symptom management. Nursing homes, where one in three American decedents live and die, have fallen short of these competency goals. We implemented an intervention study to examine the efficacy of nursing home-based integrated palliative care teams in improving the quality of care processes and outcomes for residents at the end of life.



This paper describes the design, rationale, and challenges of a two-arm randomized controlled trial of nursing home-based palliative care teams in 31 facilities. The impact of the intervention on residents' outcomes is measured with four risk-adjusted quality indicators: place of death (nursing home or hospital), number of hospitalizations, and self-reported pain and depression in the last 90-days of life. The effect of the intervention is also evaluated with regard to staff satisfaction and impact on care processes (e.g. palliative care competency, communication, coordination). Both secondary (e.g. the Minimum Data Set) and primary (e.g. staff surveys) data are employed to examine the effect of the intervention.



Several challenges in conducting a complex, nursing home-based intervention have been identified. While sustainability of the intervention without research funding is not clear, we surmise that without changes to the payment model that put palliative care services in this care setting on par with the more "skilled" care, it will not be reasonable to expect any widespread efforts to implement facility-based palliative care services.
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY 14642, United States. Electronic address: Helena_Temkin-Greener@urmc.rochester.edu.
Helena
H
Temkin-Greener
Department of Medicine, Division of Palliative Care, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, United States. Electronic address: Susan_Ladwig@urmc.rochester.edu.
Susan
S
Ladwig
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY 14642, United States. Electronic address: Zhiqiu_Ye@urmc.rochester.edu.
Zhiqiu
Z
Ye
School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States. Electronic address: Sally_Norton@urmc.rochester.edu.
Sally A
SA
Norton
Department of Medicine, 100 Theory, Suite 100, University of California, Irvine 92697-1835, United States. Electronic address: dmukamel@uci.edu.
Dana B
DB
Mukamel
D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration*; D006760:Hospitalization; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D010146:Pain / Q000453:epidemiology; D010166:Palliative Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration; D012107:Research Design; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000458:organization & administration*