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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Background
Frühzeitige spezialisierte palliativmedizinische Mitbehandlung
Gärtner, J., Wedding, U., & Alt‐Epping, B. (2015) · Der Onkologe · doi:10.1007/s00761-015-3072-4 · Cited by 9
Quality of life of patients with advanced cancer treated in a regional hospital in Greece.
Konstantinidis, T. I., Linardakis, M. K., Samonis, G., & Philalithis, A. E. (2016) · Europe PMC (PubMed Central) · Cited by 9
The palliative performance scale predicts survival among emergency department patients, Minia, Egypt
Kamal, N., & Seedhom, A. (2017) · Indian Journal of Palliative Care · doi:10.4103/ijpc.ijpc_50_17 · Cited by 9
“[6] PC has been shown to improve the quality of life and patient and caregiver satisfaction, all while decreasing costs and length of stay.[7,8]”
Background
Home-Based Palliative Care Organizations Struggle to Survive and Thrive in a Competitive Market
Rahman, A., Kogan, A. C., Lewis, N., Lomeli, S., & Enguidanos, S. M. (2022) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091211073462 · Cited by 9
“In the early 2000s, new research demonstrated that home-based palliative care (HBPC) programs also were effective.(1) Their benefits included reduced symptom burden, improved quality of life, and lower healthcare costs, achieved by preventing unnecessary hospitalizations and emergency department visits.”
BackgroundSelf-citation
Palliative Care Consultation is Associated with Decreased Rates of In-Hospital Mortality Among Patients Undergoing Major Amputation
Morton, C. R., Hayssen, H., Kawaji, Q., Kaufman, M., Blitzer, D., Uemura, T., Kheirbek, R., & Nagarsheth, K. (2022) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2022.05.005 · Cited by 9
Effect of the COVID-19 Pandemic on Place of Death Among Medicaid and Commercially Insured Patients With Cancer in Washington State
Panattoni, L. E., McDermott, C. L., Li, L., Sun, Q., Fedorenko, C. R., Sanchez, H., Kreizenbeck, K. L., Shankaran, V., & Ramsey, S. D. (2022) · Journal of Clinical Oncology · doi:10.1200/jco.22.00070 · Cited by 9
The Intersection of Need and Opportunity: Assessing and Capitalizing on Opportunities To Expand Hospital-Based Palliative Care Services
Rabow, M. W., Pantilat, S. Z., Kerr, K., Enguidanos, S. M., Ferrell, B. A., Goldstein, R., Pankratz, C., Picchi, T., Rosenfeld, K. E., & Stone, S. C. (2010) · Journal of Palliative Medicine · doi:10.1089/jpm.2010.0112 · Cited by 9
Self-citation
Palliative Care: An Evolving Field in Medicine
Eti, S. (2011) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2011.03.001 · Cited by 9
Aspectos epidemiológicos da mortalidade por câncer de boca: conhecendo os riscos para possibilitar a detecção precoce das alterações na comunicação
de Aquino, R. C. A., de Lima, M. L. L. T., de Menezes, C. R. C. X., & Vilela, M. B. R. (2015) · Revista CEFAC · doi:10.1590/1982-0216201517414914 · Cited by 9
The Use of Healthcare Services by Prostate Cancer Patients in the Last 12 Months of Life: How Do We Improve the Quality of Care During This Period?
Tien, T., Gkougkousis, E., Allchorne, P., & Green, J. S. A. (2020) · Journal of Palliative Care · doi:10.1177/0825859720975944 · Cited by 9
“5 (2-17) and 5 (0-15) for PSA <10ng/ml, 10-20ng/ml and >20ng/ml respectively.”
Impact of the Regional Palliative Care Pathway on Emergency Room Visits and Hospitalizations
Haltia, O., Hirvonen, O., Saarto, T., & Lehto, J. T. (2021) · Anticancer Research · doi:10.21873/anticanres.14934 · Cited by 8
Home and Community-Based Services: A Systematic Review and Evidence Map
Murad, M. H., Nayfeh, T., Saadi, S. M., Farah, M. H., Njeru, J. W., Viola, K. E., Chen, C. Y. Y., Prokop, L. J., & Wang, Z. (2024) · Journal of General Internal Medicine · doi:10.1007/s11606-024-08993-3 · Cited by 8
“8,16,18,20,24,26,33–35 Specific advanced disease conditions requiring more in-home assistance included people with Parkinson’s disease and related movement disorders, Alzheimer’s disease and other dementias, and post-stroke.”
Palliative Care Skills and New Resources for Oncology Practices: Meeting the Palliative Care Needs of Patients With Cancer and Their Families
Back, A. L., Friedman, T., & Abrahm, J. L. (2020) · American Society of Clinical Oncology Educational Book · doi:10.1200/edbk_100022 · Cited by 8
Comparing the Palliative Care Needs of Patients Seen by Specialty Palliative Care Teams at Home Versus in Clinic
Smith, G., Calton, B. A., Rabow, M. W., Marks, A. K., Bischoff, K. E., Pantilat, S. Z., & O’Riordan, D. L. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.11.020 · Cited by 8
Systematic review of factors influencing decisions to limit treatment in the emergency department
Walzl, N., Sammy, I. A., Taylor, P., Smith, J. E., & Lowe, D. J. (2021) · Emergency Medicine Journal · doi:10.1136/emermed-2019-209398 · Cited by 8
Integration of spiritual care into palliative care service delivery models
Beaussant, Y., Nichipor, A. N., & Balboni, T. A. (2021) · doi:10.1093/med/9780198821328.003.0101 · Cited by 8
Relationship between use of general practice and healthcare costs at the end of life: a data linkage study in New South Wales, Australia
Tran, B. N. H., Falster, M. O., Girosi, F., & Jorm, L. R. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-009410 · Cited by 8
Mortality Trends for Pediatric Life-Threatening Conditions
Chavoshi, N., Miller, T., & Siden, H. B. (2014) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909114524476 · Cited by 8
Early Integration of Palliative Care in the Care of Women with Advanced Epithelial Ovarian Cancer: The Time Is Now
Duska, L. (2016) · Frontiers in Oncology · doi:10.3389/fonc.2016.00083 · Cited by 8
Frühzeitige Integration von Palliativmedizin
Alt‐Epping, B. (2020) · Forum · doi:10.1007/s12312-020-00792-1 · Cited by 8
Evaluation of a Home-Based, Nurse Practitioner–led Advanced Illness Care Program
Ernecoff, N. C., Altieri, S. C., Bilderback, A. L., Wilson, C. L., Saxon, S., Ahuja, N., Arnold, R. M., & Boninger, M. L. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2021.05.013 · Cited by 8
Feasibility of a Palliative Care Intervention Utilizing Community Health Workers to Facilitate Delivery of Home-based Palliative Care in India
Cartmell, K. B., Kenneson, S. A. E., Roy, R., Bhattacharjee, G., Panda, N., Kumar, G., & Qanungo, S. (2022) · Indian Journal of Palliative Care · doi:10.25259/ijpc_62_21 · Cited by 8
The effectiveness of structured interdisciplinary collaboration for adult home hospice patients on patient satisfaction and hospital admissions and re-admissions: a systematic review
Joseph, R., Brown‐Manhertz, D., Ikwuazom, S., & Singleton, J. K. (2016) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2016-2254 · Cited by 8
Is patient information on palliative care good enough? A literature review and audit
Taylor, S., Wyld, L., Ziegler, L. E., & Bennett, M. (2018) · Cancer Nursing Practice · doi:10.7748/cnp.2018.e1506 · Cited by 8
Palliative Care in Advanced Lung Diseases: A Void That Needs Filling
Ruggiero, R. M., & Reinke, L. F. (2018) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201805-347hp · Cited by 8
Home‐Based Medical Care: High‐Value Health Care During Coronavirus Disease 2019 and Beyond
Fessler, E. B., Soriano, T. A., Whitehouse, C. R., & Miller, R. K. (2020) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16967 · Cited by 8
“Home-based palliative care is not new, and has been shown to improve patient satisfaction while reducing emergency room visits and hospitalizations in the last year of life.(4) More recently, advances in technology have allowed us to bring virtual palliative care support to patients in their homes.”
Background
Life-Sustaining Procedures, Palliative Care Consultation, and Do-Not Resuscitate Status in Dying Patients With COPD in US Hospitals
Shen, J. J., Ko, E., Kim, P. C., Kim, S. J., Lee, Y., Lee, J. H., & Yoo, J. W. (2018) · Journal of Palliative Care · doi:10.1177/0825859718777375 · Cited by 8
The use of hospital-based services by heart failure patients in the last year of life: a discussion paper
Singh, G. K., Davidson, P. M., Macdonald, P. S., & Newton, P. J. (2018) · Heart Failure Reviews · doi:10.1007/s10741-018-9751-7 · Cited by 8
Palliative Care’s Impact on Utilization and Costs: Implications for Health Services Research and Policy
Cassel, J. B. (2014) · Springer eBooks · doi:10.1007/978-1-4939-0407-5_8 · Cited by 8
Lebensqualität und Ethik als wichtige Grundsatzfragen der geriatrischen Onkologie
Meran, J. G., & th-Schwalbe, E. S. A. (2009) · Onkologie · doi:10.1159/000228652 · Cited by 8
Community-based neuropalliative care
Olvera, C. E., Levin, M. E., & Fleisher, J. E. (2023) · Handbook of clinical neurology · doi:10.1016/b978-0-12-824535-4.00001-x · Cited by 8
Validation of the Palliative Care and Rapid Emergency Screening (P-CaRES) Tool in Germany
Schmitz, J., Tewes, M., Mathew, B., Bubel, M., Kill, C., Riße, J., Huessler, E., Kowall, B., & Comino, M. R. S. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14072191 · Cited by 7
“Earlier access to palliative care is associated with increased mortality rates within the home environment and greater utilization of hospice services [14,15].”
Exploring the Impact of Palliative Care Education on Enhancing Quality of Life for Women with Breast Cancer
Ghati, N., Bhatnagar, S., Mahendran, M., Thakur, A., Prasad, K., Kumar, D., Dwivedi, T., Mani, K., Tiwari, P., Gupta, R., et al. (2024) · Archive of International Journal of Cancer and Allied Science · doi:10.51847/imaaacn4rh · Cited by 7
The Impact of Palliative Care Consultation on Aggressive Medical Interventions in End-of-life Among Patients with Metastatic Breast Cancer: Insights from the U.S. National Patient Sample
Zhang, Z., Lovell, A., Subramaniam, D. S., & Hinyard, L. (2024) · Journal of Palliative Care · doi:10.1177/08258597241253933 · Cited by 7
Investigating the Role of Palliative Care Education in Improving the Life Quality of Women with Breast Cancer
Ghati, N., Bhatnagar, S., Mahendran, M., Thakur, A., Prasad, K., Kumar, D., Dwivedi, T., Kalaivani, M., Tiwari, P., Gupta, R., et al. (2023) · Journal of integrative nursing and palliative care · doi:10.51847/rfsatzu8tv · Cited by 7
Community Palliative Care: What are the Best Models?
Stokes, C., & Good, P. D. (2024) · Current Treatment Options in Oncology · doi:10.1007/s11864-024-01278-1 · Cited by 7
Quality Measures for Community-Based, Rural Palliative Care Programs in Minnesota: A Pilot Study
Ceronsky, L., Johnson, L. G., & Weng, K. (2015) · Journal of Palliative Medicine · doi:10.1089/jpm.2014.0435 · Cited by 6
Health Care Utilization by Patients Whose Care Is Managed by a Primary Palliative Care Clinic
Murphy, A., Siebert, K., Owens, D. A., & Doorenbos, A. Z. (2013) · Journal of Hospice and Palliative Nursing · doi:10.1097/njh.0b013e3182a02b9d · Cited by 7
Improving community access to terminal phase medicines through the implementation of a ‘Core Medicines List’ in South Australian community pharmacies
Tait, P., Horwood, C., Hakendorf, P. H., & To, T. H. M. (2017) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2016-001191 · Cited by 7

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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