BACKGROUND: Widespread implementation of palliative care treatment plans could reduce suffering in the last days of life by adopting best practices of traditionally home-based hospice care in inpatient settings. OBJECTIVE: To evaluate the effectiveness of a multi-modal intervention strategy to improve processes of end-of-life care in inpatient settings. DESIGN: Implementation trial with an intervention staggered across hospitals using a multiple-baseline, stepped wedge design. PARTICIPANTS: Six Veterans Affairs Medical Centers (VAMCs). INTERVENTION: Staff training was targeted to all hospital providers and focused on identifying actively dying patients and implementing best practices from home-based hospice care, supported with an electronic order set and paper-based educational tools. MAIN MEASURES: Several processes of care were identified as quality endpoints for end-of-life care (last 7 days) and abstracted from electronic medical records of veterans who died before or after intervention (n = 6,066). Primary endpoints were proportion with an order for opioid pain medication at time of death, do-not-resuscitate order, location of death, nasogastric tube, intravenous line infusing, and physical restraints. Secondary endpoints were administration of opioids, order/administration of antipsychotics, benzodiazepines, and scopolamine (for death rattle); sublingual administration; advance directives; palliative care consultations; and pastoral care services. Generalized estimating equations were conducted adjusting for longitudinal trends. KEY RESULTS: Significant intervention effects were observed for orders for opioid pain medication (OR: 1.39), antipsychotic medications (OR: 1.98), benzodiazepines (OR: 1.39), death rattle medications (OR: 2.77), sublingual administration (OR: 4.12), nasogastric tubes (OR: 0.71), and advance directives (OR: 1.47). Intervention effects were not significant for location of death, do-not-resuscitate orders, intravenous lines, or restraints. CONCLUSIONS: This broadly targeted intervention strategy led to modest but statistically significant changes in several processes of care, indicating its potential for widespread dissemination to improve end-of-life care for thousands of patients who die each year in inpatient settings.
BACKGROUND: Widespread implementation of palliative care treatment plans could reduce suffering in the last days of life by adopting best practices of traditionally home-based hospice care in inpatient settings. OBJECTIVE: To evaluate the effectiveness of a multi-modal intervention strategy to improve processes of end-of-life care in inpatient settings. DESIGN: Implementation trial with an intervention staggered across hospitals using a multiple-baseline, stepped wedge design. PARTICIPANTS: Six Veterans Affairs Medical Centers (VAMCs). INTERVENTION: Staff training was targeted to all hospital providers and focused on identifying actively dying patients and implementing best practices from home-based hospice care, supported with an electronic order set and paper-based educational tools. MAIN MEASURES: Several processes of care were identified as quality endpoints for end-of-life care (last 7 days) and abstracted from electronic medical records of veterans who died before or after intervention (n = 6,066). Primary endpoints were proportion with an order for opioid pain medication at time of death, do-not-resuscitate order, location of death, nasogastric tube, intravenous line infusing, and physical restraints. Secondary endpoints were administration of opioids, order/administration of antipsychotics, benzodiazepines, and scopolamine (for death rattle); sublingual administration; advance directives; palliative care consultations; and pastoral care services. Generalized estimating equations were conducted adjusting for longitudinal trends. KEY RESULTS: Significant intervention effects were observed for orders for opioid pain medication (OR: 1.39), antipsychotic medications (OR: 1.98), benzodiazepines (OR: 1.39), death rattle medications (OR: 2.77), sublingual administration (OR: 4.12), nasogastric tubes (OR: 0.71), and advance directives (OR: 1.47). Intervention effects were not significant for location of death, do-not-resuscitate orders, intravenous lines, or restraints. CONCLUSIONS: This broadly targeted intervention strategy led to modest but statistically significant changes in several processes of care, indicating its potential for widespread dissemination to improve end-of-life care for thousands of patients who die each year in inpatient settings.
Authors: F Amos Bailey; Kathryn L Burgio; Lesa L Woodby; Beverly R Williams; David T Redden; Stacey H Kovac; Rosie M Durham; Patricia S Goode Journal: Arch Intern Med Date: 2005 Aug 8-22
Authors: Ebun A Abarshi; Michael A Echteld; Lieve Van den Block; Gé A Donker; Luc Deliens; Bregje D Onwuteaka-Philipsen Journal: Br J Gen Pract Date: 2011-06 Impact factor: 5.386
Authors: Glenn Gade; Ingrid Venohr; Douglas Conner; Kathleen McGrady; Jeffrey Beane; Robert H Richardson; Marilyn P Williams; Marcia Liberson; Mark Blum; Richard Della Penna Journal: J Palliat Med Date: 2008-03 Impact factor: 2.947
Authors: Laura C Hanson; Frances Collichio; Stephen A Bernard; William A Wood; Matt Milowsky; Erin Burgess; Crista J Creedle; Summer Cheek; Lydia Chang; Bhisham Chera; Alexandra Fox; Feng-Chang Lin Journal: J Palliat Med Date: 2017-07-24 Impact factor: 2.947
Authors: Elizabeth Kvale; J Nicholas Dionne-Odom; David T Redden; F Amos Bailey; Marie Bakitas; Patricia S Goode; Beverly R Williams; Kathlyn Sue Haddock; Kathryn L Burgio Journal: J Palliat Med Date: 2015-04-30 Impact factor: 2.947
Authors: Michael Hoerger; Laura M Perry; Robert Gramling; Ronald M Epstein; Paul R Duberstein Journal: Health Psychol Date: 2017-03-09 Impact factor: 4.267
Authors: Paul R Duberstein; Richard L Kravitz; Joshua J Fenton; Guibo Xing; Daniel J Tancredi; Michael Hoerger; Supriya G Mohile; Sally A Norton; Holly G Prigerson; Ronald M Epstein Journal: J Pain Symptom Manage Date: 2019-04-18 Impact factor: 3.612
Authors: Kathryn L Burgio; Beverly R Williams; J Nicholas Dionne-Odom; David T Redden; Hyunjin Noh; Patricia S Goode; Elizabeth Kvale; Marie Bakitas; F Amos Bailey Journal: J Palliat Med Date: 2016-02 Impact factor: 2.947
Authors: Paul R Duberstein; Michael Chen; Michael Hoerger; Ronald M Epstein; Laura M Perry; Sule Yilmaz; Fahad Saeed; Supriya G Mohile; Sally A Norton Journal: J Pain Symptom Manage Date: 2019-10-19 Impact factor: 3.612
Authors: Kathleen E Bickel; Richard Kennedy; Cari Levy; Kathryn L Burgio; F Amos Bailey Journal: J Gen Intern Med Date: 2019-12-02 Impact factor: 5.128