Cited by 845Palliative Care and End-of-Life IssuesPalliative and Oncologic CarePain Management and Opioid Use

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Increased Satisfaction with Care and Lower Costs: Results of a Randomized Trial of In‐Home Palliative Care

Brumley, Richard, Enguidanos, Susan, Jamison, Paula, Seitz, Rae, Morgenstern, Nora, Saito, Sherry, McIlwane, Jan, Hillary, Kristine, Gonzalez, Jorge·2007·Journal of the American Geriatrics Society

DOI 10.1111/j.1532-5415.2007.01234.x

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Abstract

OBJECTIVES: To determine whether an in‐home palliative care intervention for terminally ill patients can improve patient satisfaction, reduce medical care costs, and increase the proportion of patients dying at home. DESIGN: A randomized, controlled trial. SETTING: Two health maintenance organizations in two states. PARTICIPANTS: Homebound, terminally ill patients (N=298) with a prognosis of approximately 1 year or less to live plus one or more hospital or emergency department visits in the previous 12 months. INTERVENTION: Usual versus in‐home palliative care plus usual care delivered by an interdisciplinary team providing pain and symptom relief, patient and family education and training, and an array of medical and social support services. MEASUREMENTS: Measured outcomes were satisfaction with care, use of medical services, site of death, and costs of care. RESULTS: Patients randomized to in‐home palliative care reported greater improvement in satisfaction with care at 30 and 90 days after enrollment ( P <.05) and were more likely to die at home than those receiving usual care ( P <.001). In addition, in‐home palliative care subjects were less likely to visit the emergency department ( P =.01) or be admitted to the hospital than those receiving usual care ( P <.001), resulting in significantly lower costs of care for intervention patients ( P =.03). CONCLUSION: In‐home palliative care significantly increased patient satisfaction while reducing use of medical services and costs of medical care at the end of life. This study, although modest in scope, presents strong evidence for reforming end‐of‐life care.

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Fraser, T., Page-Tan, C. M., & Aldrich, D. P. (2021) · Scientific Reports · doi:10.1038/s41598-022-10275-z · Cited by 64
Association Between Palliative Case Management and Utilization of Inpatient, Intensive Care Unit, Emergency Department, and Hospice in Medicaid Beneficiaries
Wang, L., Piet, L., Kenworthy, C. M., & Dy, S. M. (2014) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909113520067 · Cited by 48
“Patients with in-home palliative care were found less likely to visit emergency departments (EDs) or to be admitted to hospitals, and more likely to die at home, than those with usual care.(9) In an inpatient utilization analysis, Seow at al(10) examined inpatient utilization in the last 7 days of life of the patients…”
Background
Palliative care in decompensated cirrhosis: A review
Langberg, K. M., Kapo, J. M., & Taddei, T. H. (2017) · Liver International · doi:10.1111/liv.13620 · Cited by 49
Social Workers' Perspectives on Care Arrangements Between Vulnerable Elders and Foreign Home Care Workers: Lessons from Israeli/Filipino Caregiving Arrangements
Ayalon, L., Kaniel, M., & Rosenberg, L. (2008) · Home Health Care Services Quarterly · doi:10.1080/01621420802022563 · Cited by 48
Health Care Provider Barriers to Patient Referral to Palliative Care
Enguidanos, S. M., Cardenas, V., Wenceslao, M., Hoe, D. F., Mejia, K., Lomeli, S., & Rahman, A. (2020) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909120973200 · Cited by 47
Self-citation
Clinical Impact of a Home-Based Palliative Care Program: A Hospice-Private Payer Partnership
Kerr, C. W., Tangeman, J. C., Rudra, C. B., Grant, P. C., Luczkiewicz, D. L., Mylotte, K. M., Riemer, W. D., Marien, M. J., & Serehali, A. M. (2014) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2014.02.003 · Cited by 47
Early Implementation of Palliative Care Can Improve Patient Outcomes
Glare, P. A. (2013) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2013.0212 · Cited by 47
Filling the Gap: Creating an Outpatient Palliative Care Program in Your Institution
Finlay, E. E., Rabow, M. W., & Buss, M. K. (2018) · American Society of Clinical Oncology Educational Book · doi:10.1200/edbk_200775 · Cited by 47
Psychosocial, cultural, and spiritual health disparities in end-of-life and palliative care: Where we are and where we need to go
Evans, B. C., & Ume, E. (2012) · Nursing Outlook · doi:10.1016/j.outlook.2012.08.008 · Cited by 47
“Although there are few end of life palliative care interventions employing an Asian sample, there is one randomized controlled trial with sites in Hawaii and Colorado (Brumley et al., 2007).”
Background
Palliative Care Consultation Reduces Heart Failure Transitions: A Matched Analysis
Diop, M. S., Bowen, G. S., Jiang, L., Wu, W., Cornell, P. Y., Gozalo, P. L., & Rudolph, J. L. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.119.013989 · Cited by 49
Comparison of terminally ill cancer- vs. non-cancer patients in specialized palliative home care in Germany – a single service analysis
Stiel, S., Heckel, M., Seifert, A., Frauendorf, T., Hanke, R. M., & Ostgathe, C. (2015) · BMC Palliative Care · doi:10.1186/s12904-015-0033-z · Cited by 46
“On the other hand, these goals may also be encouraged by policy makers and health care insurances who intended SPHC teams to keep patients stable at home, while saving costs on expensive, long-term hospital stays [1, 12].”
Background
Home-based specialized palliative care in patients with advanced cancer: A systematic review
Nordly, M., Vadstrup, E. S., Sjøgren, P., & Kurita, G. P. (2016) · Palliative & Supportive Care · doi:10.1017/s147895151600050x · Cited by 46
“…of SPC, such as increased patient satisfaction, enhanced QoL, symptom improvement, fewer hospitalizations, and a higher frequency of dying at home (Brumley et al., 2007; Rabow et al., 2004; Hanks et al., 2002; Follwell et al., 2009; Zimmer et al., 1985; Groh et al., 2013); however, heterogeneous…”
Background
YouTube Videos as a Source of Palliative Care Education: A Review
Liu, M., Cardenas, V., Zhu, Y., & Enguidanos, S. M. (2019) · Journal of Palliative Medicine · doi:10.1089/jpm.2019.0047 · Cited by 46
Self-citation
Cost Savings Associated With Palliative Care Among Older Adults With Advanced Cancer
Sheridan, P. E., LeBrett, W. G., Triplett, D. P., Roeland, E. J., Bruggeman, A. R., Yeung, H. N., & Murphy, J. D. (2021) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909120986800 · Cited by 46
“Our results complement the findings of prior single and multiple institution studies that find associations between palliative care and reductions in healthcare costs.(7,15,17,35,36) The present study extends this work to include a population-based study that includes total cost savings associated with palliative care.”
Result
Long-Term Effect of an Interdisciplinary Supportive Care Intervention for Lung Cancer Survivors After Surgical Procedures
Raz, D. J., Sun, V. C.-Y., Kim, J. Y., Williams, A. C., Koczywas, M., Cristea, M. C., Reckamp, K. L., Hayter, J., Tiep, B. L., & FERRELL, B. R. (2015) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2015.07.031 · Cited by 45
“lung cancer [5–8] The Institute of Medicine recommends palliative/supportive care interventions across the continuum of care [9].”
Background
Avoidable 30-Day Readmissions Among Patients With Stroke and Other Cerebrovascular Disease
Nahab, F. B., Takesaka, J., Mailyan, E., Judd, L., Culler, S. D., Webb, A., Frankel, M., Choi, D. W., & Helmers, S. L. (2011) · The Neurohospitalist · doi:10.1177/1941874411427733 · Cited by 45
“Palliative care supportive services have been shown to improve patient satisfaction and decrease hospital readmission rates as well as lower costs of care in patients with terminal illnesses.(10) Efforts should be made to identify hospice-appropriate stroke patients who may benefit from palliative care services to cla…”
Background
The Appropriate Provision of Primary versus Specialist Palliative Care to Cancer Patients: Oncologists' Perspectives
Gidwani, R. A., Nevedal, A., Patel, M. I., Blayney, D. W., Timko, C., Ramchandran, K. J., Kelly, P. A., & Asch, S. M. (2016) · Journal of Palliative Medicine · doi:10.1089/jpm.2016.0399 · Cited by 45
Predictive model of complexity in early palliative care: a cohort of advanced cancer patients (PALCOM study)
Tuca, A., Gómez-Martínez, M., & Prat, A. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3840-3 · Cited by 45
Reluctance to Accept Palliative Care and Recommendations for Improvement: Findings From Semi-Structured Interviews With Patients and Caregivers
Cardenas, V., Rahman, A., Zhu, Y., & Enguidanos, S. M. (2021) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091211012605 · Cited by 46
Self-citation
Palliative Access Through Care at Home: Experiences with an Urban, Geriatric Home Palliative Care Program
Holley, A. P. H., Gorawara‐Bhat, R., Dale, W., Hemmerich, J., & Cox‐Hayley, D. (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2009.02452.x · Cited by 45
“-based programs have been documented.(25,26) These studies found that home-based PC may decrease emergency department visits and hospitalizations, improve advance care planning, increase the number of in-home deaths, improve symptom control, and increase patient and family satisfaction, but none of these programs focu…”
Background
United States Best Practice Guidelines for Primary Palliative Care in the Emergency Department
Loffredo, A. J., Chan, G. K., Wang, D. H., Goett, R. R., Isaacs, E., Pearl, R., Rosenberg, M. S., Aberger, K., & Lamba, S. (2021) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2021.05.021 · Cited by 45
“49 53-58 Palliative care ’ s focus on the whole patient and clinician could also advance the quadruple aim: improving the patient experience, population health, cost stewardship, and emotional betterment of health care clinicians and staff.”
Background
The Ambulatory and Home Care Record: A Methodological Framework for Economic Analyses in End-of-Life Care
Guerriere, D. N., & Coyte, P. C. (2011) · Journal of Aging Research · doi:10.4061/2011/374237 · Cited by 44
“Studies which have assessed the cost of home-based endof-life care have either compared home-based programs to institutionally based end-of-life care or to regular homebased care [3, 4, 29, 38], looked at changes in costs after the introduction of home-based end-of-life care programs [40], or measured costs of a home-…”
Financial Impact of Palliative Care Consultation in a Public Hospital
Bendaly, E. A., Groves, J., Juliar, B. E., & Gramelspacher, G. P. (2008) · Journal of Palliative Medicine · doi:10.1089/jpm.2008.0077 · Cited by 44
Resource utilization and cost analyses of home-based palliative care service provision: The Niagara West End-of-Life Shared-Care Project
Klinger, C. A., Howell, D., Marshall, D., Zakus, D., Brazil, K., & Deber, R. B. (2012) · Palliative Medicine · doi:10.1177/0269216311433475 · Cited by 44
Integrating early palliative care into routine practice for patients with cancer: A mixed methods evaluation of the INTEGRATE Project
Evans, J. M., MacKinnon, M., Pereira, J. L., Earle, C. C., Gagnon, B., Arthurs, E., Gradin, S., Buchman, S., & Wright, F. C. (2019) · Psycho-Oncology · doi:10.1002/pon.5076 · Cited by 44
“Introducing palliative care early in the patient care trajectory for patients with advanced or aggressive illnesses results in improved symptom control, better quality of life, less aggressive care, less distress among family caregivers, and longer survival compared with patients receiving standard care.(2-9) With inc…”
Background
The Utilization of Palliative Care Services in Patients with Cirrhosis who have been Denied Liver Transplantation: A Single Center Retrospective Review
Kelly, S. G., Campbell, T. C., Hillman, L., Said, A., Lucey, M. R., & Agarwal, P. D. (2017) · Annals of Hepatology · doi:10.5604/01.3001.0009.8594 · Cited by 44
The Branding of Palliative Care
Berry, L. L., Castellani, R., & Stuart, B. (2016) · Journal of Oncology Practice · doi:10.1200/jop.2015.008656 · Cited by 44
Reasons for hospitalisation at the end of life: differences between cancer and non-cancer patients
Korte-Verhoef, M. C. D., Pasman, H. R. W., Schweitzer, B. P. M., Francke, A. L., Onwuteaka-Philipsen, B. D., & Deliëns, L. (2013) · Supportive Care in Cancer · doi:10.1007/s00520-013-2019-9 · Cited by 42
Emergency Medicine Palliative Care Access (EMPallA): protocol for a multicentre randomised controlled trial comparing the effectiveness of specialty outpatient versus nurse-led telephonic palliative care of older adults with advanced illness
Grudzen, C. R., Shim, D. J., Schmucker, A. M., Cho, J., & Goldfeld, K. S. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-025692 · Cited by 42
Setting priorities in and for end-of-life care: challenges in the application of economic evaluation
Normand, C. E. M. (2012) · Health Economics Policy and Law · doi:10.1017/s1744133112000229 · Cited by 41
“Some studies also include limited measures of patient outcome or experience (Fassbender et al., 2005; Brumley et al., 2007; Tamir et al., 2007; Taylor et al., 2007; Hanson et al., 2008).”
Background
Emergency Department-Based Palliative Interventions: A Novel Approach to Palliative Care in the Emergency Department
Reuter, Q. R., Marshall, A., Zaidi, H. Q., Sista, P., Powell, E. S., McCarthy, D. M., & Dresden, S. M. (2019) · Journal of Palliative Medicine · doi:10.1089/jpm.2018.0341 · Cited by 41
The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study
Hirvonen, O., Leskelä, R., Grönholm, L., Haltia, O., Voltti, S., Tyynelä-Korhonen, K., Rahko, E. K., Lehto, J. T., & Saarto, T. (2020) · BMC Palliative Care · doi:10.1186/s12904-020-00547-8 · Cited by 41
Continuity, Coordination, and Transitions of Care for Patients with Serious and Advanced Illness: A Systematic Review of Interventions
Dy, S. M., Apostol, C. C., Martinez, K. A., & Aslakson, R. A. (2013) · Journal of Palliative Medicine · doi:10.1089/jpm.2012.0317 · Cited by 41
“The most recent review on specialized palliative care in cancer 25 included a wider range of studies than in our review, including retrospective and uncontrolled studies, and found Several older systematic reviews have addressed the target of continuity in related areas, although focusing on…”
Association of healthcare expenditures with aggressive versus palliative care for cancer patients at the end of life: a cross-sectional study using claims data in Japan
Morishima, T., Lee, J., Otsubo, T., & Imanaka, Y. (2013) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzt081 · Cited by 40
“Other studies have shown that physician home care is associated with good QOL and better satisfaction at EOL [4, 27, 28].”
Result
Dying of amyotrophic lateral sclerosis
Zwicker, J. C., Qureshi, D., Talarico, R., Bourque, P. R., Scott, M., Chin-Yee, N. J., & Tanuseputro, P. (2019) · Neurology · doi:10.1212/wnl.0000000000008582 · Cited by 40
“, nursing homes) and complex continuing care (those in designated complex, nonacute institutional care beds); (9) Statistics Canada Census data, for income quintile and rurality through postal codes; and (10) the Ontario Drug Benefit claims database, for capturing prescription drug use for those aged 65 and older.”
BackgroundInfluential
Factors Associated with End-of-Life Health Service Use in Patients Dying of Cancer
Barbera, L. C., SUSSMAN, J. S., Viola, R., Husain, A. F., Howell, D., Librach, S., Walker, H. D., Sutradhar, R., Chartier, C., & Paszat, L. F. (2010) · Healthcare policy · doi:10.12927/hcpol.2013.21644 · Cited by 40

Authors: Brumley, R., Enguidanos, S., Jamison, P., Seitz, R., Morgenstern, N., Saito, S., McIlwane, J., Hillary, K., & Gonzalez, J.
Affiliations: Kaiser Permanente (US)
Partners in Care Foundation (US)
ORCID: Enguidanos, Susan
Venue: Journal of the American Geriatrics Society
Publisher: Wiley
Published: 2007-06-18
Volume: 55
Issue: 7
Pages: 993-1000
ISSN: 0002-8614 (ISSN-L)
1532-5415
DOI: 10.1111/j.1532-5415.2007.01234.x
OpenAlex: W2108517568
Cited by: 845
References: 28
Citations by year: 2026: 20 · 2025: 20 · 2024: 39 · 2023: 25 · 2022: 46 · 2021: 56 · 2020: 67 · 2019: 54 · 2018: 56 · 2017: 69 · 2016: 76 · 2015: 63 · 2014: 66 · 2013: 54 · 2012: 41
FWCI: 19.56
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Journal of the American Geriatrics Society (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords: end-of-life care, patient satisfaction, health care costs, home death, dying patients, homebound patients, emergency department visits, hospitalization, interdisciplinary care teams, symptom management, health maintenance organizations
MeSH terms: Aged, Female, Health Maintenance Organizations, Home Care Services, Humans, Male, Palliative Care, Patient Education as Topic, Prognosis, Retrospective Studies, Health Care Costs, Patient Satisfaction, Terminally Ill

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Increased Satisfaction with Care and Lower Costs: Results of a Randomized Trial of In‐Home Palliative Care

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