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Increased Satisfaction with Care and Lower Costs: Results of a Randomized Trial of In‐Home Palliative Care
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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“Outcomes were worse with first-line erlotinib, followed by an immediate switch to chemotherapy at progression.”
From Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (2015) · cites this paper as [102]
In the citing paper
“There was crossover in this study, so the authors could not analyze the association of mutation status with OS.”
From Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (2015) · cites this paper as [102]
In the citing paper
“In the trial by Gridelli et al,102 which was stopped early and is discussed under Recommendation B1, participants were unselected for EGFR mutation status; 13.8% of the participants in the intervention arm and 14.6% in the control arm had EGFR mutation–positive disease.”
From Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (2015) · cites this paper as [102]
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“Anxiety 5 (9) 4 (7) Appetite loss 3 (5) 4 (7) Constipation 10 (17) 14 (24) Confusion 0 (0) 2 (3) Cough 1 (2) 2 (3) Delirium 6 (10) 9 (16) Depression 3 (5) 4 (7) Diarrhea 1 (2) 1 (2) Drowsiness 2 (3) 1 (2) Dysphagia 0 (0) 1 (2) Dyspnea 9 (16) 12 (21) Fatigue 5 (9) 9 (16) Headache 1 (2) 1 (2) Itching 0 (0) 1 (2) Nausea…”
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“Otros estudios han evidenciado que el cuidado paliativo ahorra costos directos por paciente [9,10]; además que disminuyen costos al sistema de salud con aquellos pacientes con enfermedades crónicas, representados en una reducción en el número de días de estancia en unidades de cuidado intensivo, días de estancia hospi…”
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“Another in-home PC randomized trial found PC significantly increased patient satisfaction while reducing use of medical services and costs of medical care at the end of life [4].”
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“감소시키고 응급실 방문과 입원 등의 의료이용을 낮춤으로 써 의료비용 감소에 유의한 영향을 미치는 것으로 보고하였 다[9-11].”
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“(2007) obtained in their research.(29) The scores for the stages of immediately and one month after the EP were only significantly different that of three months after the EP.”
Result[Significance and current development status of pediatric palliative care].
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Viswanath, V., Digumarti, L., Raju, N. S., Lokanandi, U. R. V., Dasu, M. R., Bolem, S. K. V., Katta, N., Vemula, S. R., Sharma, V. V. L. N., & Digumarti, R. (2021) · Indian Journal of Palliative Care · doi:10.25259/ijpc_370_20 · Cited by 4
Patel, R. P., Patel, M., Patel, D., Yang, C., Onyechi, A., Ohemeng‐Dapaah, J., Patel, Z., & Shaikh, S. (2024) · Journal of Kidney Cancer and VHL · doi:10.15586/jkcvhl.v11i1.314 · Cited by 4
“When we looked into the service use analysis, significantly lower proportions of emergency department visits and hospitalization were discovered (4).”
BackgroundIs There a Role for Palliative Services and Supportive Care in Managing Advanced Penile Cancer?
Hugar, L. A., Filippou, P. L., Thirlwell, S., Spiess, P. E., & Wulff-Burchfield, E. M. (2022) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2022.151288 · Cited by 4
A Model to Improve Value: The Interdisciplinary Palliative Care Services Agreement
Porter-Williamson, K. B., Parker, M., Babbott, S. F., Steffen, P., & Stites, S. W. (2009) · Journal of Palliative Medicine · doi:10.1089/jpm.2009.0014 · Cited by 4
“21,33,34 Our data are consistent with these findings.”
Kirkendall, A. M., Shen, J. J., & Gan, Y. (2014) · PubMed · Cited by 4
Better Care and Better Value for Canadians: A Review of RCT Studies of Nurse Interventions
Browne, G., Birch, S., & Thabane, L. (2015) · Canadian Journal of Nursing Research · doi:10.1177/084456211504700405 · Cited by 6
Assareh, H., Stubbs, J. M., Trinh, L. T. T., Muruganantham, P., Jalaludin, B. B., & Achat, H. M. (2019) · Journal of Aging and Health · doi:10.1177/0898264319848582 · Cited by 4
“…care at the local level (Chiang, Kao, & Lai, 2015; Wright et al., 2017), and (b) facilitate access and increase use by removing potential individual-level barriers in awareness, communication, and financial burden (Bakitas et al., 2009; Brumley et al., 2007; Zhang, Wright, Huskamp, & et al, 2009).”
BackgroundInfluentialBehm, B. (2022) · Digital Archive @ GSU · doi:10.57709/7030577 · Cited by 4
Homeward Bound, not hospital rebound: how transitional palliative care can reduce readmission
Kavalieratos, D., Rollman, B. L., & Arnold, R. M. (2016) · Heart · doi:10.1136/heartjnl-2016-309385 · Cited by 4
COVID-19 To Go? The Role of Disasters and Evacuation in the COVID-19 PandemicPreprint
Page-Tan, C. M., & Fraser, T. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3836258 · Cited by 4
A systematic review of perinatal palliative care models: challenges and opportunities for the future
Zanin, A., Salerno, A., Cavicchiolo, M. E., Daicampi, C., Martini, B., Marinetto, A., Salvadori, S., & Benini, F. (2025) · European Journal of Pediatrics · doi:10.1007/s00431-025-06459-0 · Cited by 5
“Evidence from adult and pediatric non-NICU populations demonstrates that specialized palliative care services correlate with reduced caregiver stress, improved satisfaction, and cost savings [41–44].”
Chotalia, R., Mohiaddin, H., Aggarwal, A., Borchardt, E., Ambrogetti, R., Chotalia, M., Squire, I., & Sze, S. (2026) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091261446602 · Cited by 2
Fansiwala, K. M., Rajpal, N., Noorian, S., Dua, A., Chen, P., & Limketkai, B. N. (2023) · Gastro Hep Advances · doi:10.1016/j.gastha.2023.01.002 · Cited by 4
Symptom Burden and Survival in Patients Receiving Outpatient and Home-Based Palliative Care
Haupt, E. C., Sharma, I., & Nguyen, H. Q. (2023) · Journal of Palliative Medicine · doi:10.1089/jpm.2022.0267 · Cited by 3
Complex, Chronic, and End-of-Life Care
Freysteinson, W. M. (2010) · Critical Care Nursing Quarterly · doi:10.1097/cnq.0b013e3181e6606b · Cited by 2
Physician Home Visits by Palliative Medicine Fellow
Ang, S. K., LeGrand, S. B., Walsh, D., Davis, M. P., & Lagman, R. L. (2011) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909111409740 · Cited by 3
“Studies have shown that a physician HV is a predictor of death at home.(13,14,17,18,20,21) Persons who are able to die in their home or a residential hospice unit may reduce health care utilization, costs,(7,9,14,20,21) and improve family satisfaction.”
BackgroundPalliative care programs for patients with breast cancer: the benefits of home-based care
Seow, H. Y., Bainbridge, D. B., & Bryant, D. (2013) · Breast Cancer Management · doi:10.2217/bmt.13.39 · Cited by 3
Cabrera‐León, A., Carretero, M. J. E., Suess, A., Román, P. R., Ramos, R. C., & Amores, R. S. (2013) · Medicina Paliativa · doi:10.1016/j.medipa.2013.02.005 · Cited by 3
Palliative Management and End-of-Life Care in Nonmalignant Advanced Lung Disease
Khateeb, D. M., & West, F. M. (2017) · Clinical Pulmonary Medicine · doi:10.1097/cpm.0000000000000229 · Cited by 3
Prod’homme, C. (2020) · Bulletin du Cancer · doi:10.1016/j.bulcan.2020.08.015 · Cited by 3
Kadu, M., Mondor, L., Hsu, A. T., Webber, C., Howard, M., & Tanuseputro, P. (2021) · Palliative Medicine Reports · doi:10.1089/pmr.2020.0095 · Cited by 4
“Home-based palliative care teams can improve communication among patients, their caregivers, and primary care physicians about goals of care and initiate discussions about treatment selection in the comfort of their home.(10,13) Despite this, only one in five individuals who are at their end of life receive home-based…”
BackgroundProgram evaluation: improving the quality of life of older people in an urban slum in Bangladesh
Chowdhury, M. K., Ahmad, N., Biswas, F. N., Farheen, N., Ferdous, L., Akter, K. M., & Connor, S. R. (2021) · Palliative Care and Social Practice · doi:10.1177/26323524211063217 · Cited by 3
Impact of the Timing of Integrated Home Palliative Care Enrolment on Emergency Department Visits
Scacchi, A., Savatteri, A., Politano, G. M. M., Conti, A., Dalmasso, M., Campagna, S., & Gianino, M. M. (2022) · International Journal of Health Policy and Management · doi:10.34172/ijhpm.2022.5783 · Cited by 3
Hentsch, L., Pereira, C., Pinon, N., Tahar, A., & Pautex, S. (2023) · Palliative & Supportive Care · doi:10.1017/s1478951523000056 · Cited by 3
“…to support the introduction of palliative care early in the course of all life-limiting diseases, including for patients suffering from non-oncological diseases (Brumley et al. 2007; Greer et al. 2013; Hauptman and Havranek 2005; Parikh et al. 2013; Salins et al. 2016; Temel et al. 2017, 2010).”
Scott, M., Webber, C., Clarke, A. E., Hafid, S., Isenberg, S. R., Jones, A., Hsu, A. T., Conen, K. L., Downar, J., Manuel, D. G., et al. (2023) · CMAJ Open · doi:10.9778/cmajo.20220123 · Cited by 3
Salins, N. S., Hughes, S. P. F., & Preston, N. J. (2024) · BMC Palliative Care · doi:10.1186/s12904-024-01517-0 · Cited by 3
“It improved quality of life, enhanced symptom control, bettered communication, informed treatment decision-making, advance care planning, end-of-life care, and reduced costs [36–41].”
BackgroundYin, G., Macaden, L., Sivaramakrishnan, D., Wang, Y., Zhu, L., & Chong, H. (2024) · Dementia · doi:10.1177/14713012241308625 · Cited by 4
“However, despite the many advantages of home end-of-life care, which have been favorably viewed in several studies (Brumley et al., 2007; Gomes et al., 2016), current evidence shows mixed fi ndings on the ultimate practical outcomes of end-of-life care at home, particularly as some studies have…”
Cohen‐Mansfield, J., Skornick-Bouchbinder, M., Hoshen, M. B., & Brill, S. (2017) · Health Policy · doi:10.1016/j.healthpol.2017.07.004 · Cited by 3
Metadata
- 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
- 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
- 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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