A randomized controlled trial of a novel home-based palliative care program: A report of a trial that could not be completed

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-06-01 DOI:10.1111/jgs.19022

Nathan E. Goldstein MD, Shira Winter PhD, RN, FNP-BC, Harriet Mather MD, MSc, Linda V. DeCherrie MD, Amy S. Kelley MD, MSHS, Karen McKendrick MPH, Duzhi Zhao BS, MS, Christian Espino BA, LaToya Sealy FNP-BC, Meng Zhang MD, R. Sean Morrison MD

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引用次数: 0

Abstract

Background

In response to a growing need for accessible, efficient, and effective palliative care services, we designed, implemented, and evaluated a novel palliative care at home (PC@H) model for people with serious illness that is centered around a community health worker, a registered nurse, and a social worker, with an advanced practice nurse and a physician for support. Our objectives were to measure the impact of receipt of PC@H on patient symptoms, quality of life, and healthcare utilization and costs.

Methods

We enrolled 136 patients with serious illness in this parallel, randomized controlled trial. Our primary outcome was change in symptom burden at 6 weeks. Secondary outcomes included change in symptom burden at 3 months, change in quality of life at 6 weeks and 3 months, estimated using a group t-test. In an exploratory aim, we examined the impact of PC@H on healthcare utilization and cost using a generalized linear model.

Results

PC@H resulted in a greater improvement in patient symptoms at 6 weeks (1.30 score improvement, n = 37) and 3 months (3.14 score improvement, n = 21) compared with controls. There were no differences in healthcare utilization and costs between the two groups. Unfortunately, due to the COVID-19 pandemic and a loss of funding, the trial was not able to be completed as originally intended.

Conclusions

A palliative care at home model that leverages community health workers, registered nurses, and social workers as the primary deliverers of care may result in improved patient symptoms and quality of life compared with standard care. We did not demonstrate significant differences in healthcare utilization and cost associated with receipt of PC@H, likely due to inability to reach the intended sample size and insufficient statistical power, due to elements beyond the investigators' control such as the COVID-19 public health emergency and changes in grant funding.

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一项新型居家姑息关怀项目的随机对照试验：一份未能完成的试验报告。

背景为了满足人们对便捷、高效、有效的姑息关怀服务日益增长的需求，我们为重症患者设计、实施并评估了一种新型的居家姑息关怀（PC@H）模式，该模式以一名社区卫生工作者、一名注册护士和一名社会工作者为中心，并由一名高级执业护士和一名医生提供支持。我们的目标是衡量接受 PC@H 对患者症状、生活质量、医疗利用率和成本的影响：我们在这项平行随机对照试验中招募了 136 名重症患者。我们的主要结果是 6 周后症状负担的变化。次要结果包括症状负担在 3 个月后的变化、生活质量在 6 周和 3 个月后的变化（使用组 t 检验进行估计）。在探索性研究中，我们使用广义线性模型研究了 PC@H 对医疗利用率和成本的影响：结果：与对照组相比，PC@H 使患者的症状在 6 周（改善 1.30 分，n=37）和 3 个月（改善 3.14 分，n=21）时得到更大改善。两组患者在医疗利用率和费用方面没有差异。遗憾的是，由于 COVID-19 大流行和资金短缺，试验未能按原计划完成：结论：与标准护理相比，利用社区卫生工作者、注册护士和社会工作者作为主要护理提供者的居家姑息关怀模式可能会改善患者的症状和生活质量。我们没有证明接受 PC@H 在医疗利用率和成本方面存在显著差异，这可能是由于研究人员无法控制的因素（如 COVID-19 公共卫生突发事件和资助资金的变化）导致无法达到预期样本量和统计能力不足。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.