Helena Temkin-Greener1, Dana B Mukamel2, Heather Ladd3, Susan Ladwig4, Thomas V Caprio4, Sally A Norton5, Timothy E Quill4, Tobie H Olsan5, Xueya Cai6. 1. Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. 2. Department of Medicine, iTEQC Research Program University of California. 3. Department of Medicine, University of California, Irvine, CA. 4. Department of Medicine, University of Rochester School of Medicine and Dentistry. 5. School of Nursing, University of Rochester. 6. Department of Biostatistics & Computational Biology, University of Rochester, Rochester, NY.
Abstract
BACKGROUND: Deficits in end-of-life care in nursing homes (NHs) are reported, but the impact of palliative care teams (PCTeams) on resident outcomes remains largely untested. OBJECTIVE: Test the impact of PCTeams on end-of-life outcomes. RESEARCH DESIGN: Multicomponent strategy employing a randomized, 2-arm controlled trial with a difference-in-difference analysis, and a nonrandomized second control group to assess the intervention's placebo effect. SUBJECTS: In all, 25 New York State NHs completed the trial (5830 decedent residents) and 609 NHs were in the nonrandomized group (119,486 decedents). MEASURES: Four risk-adjusted outcome measures: place of death, number of hospitalizations, self-reported moderate-to-severe pain, and depressive symptoms. The Minimum Data Set, vital status files, staff surveys, and in-depth interviews were employed. For each outcome, a difference-in-difference model compared the pre-post intervention periods using logistic and Poisson regressions. RESULTS: Overall, we found no statistically significant effect of the intervention. However, independent analysis of the interview data found that only 6 of the 14 treatment facilities had continuously working PCTeams throughout the study period. Decedents in homes with working teams had significant reductions in the odds of in-hospital death compared to the other treatment [odds ratio (OR), 0.400; P<0.001), control (OR, 0.482; P<0.05), and nonrandomized control NHs (0.581; P<0.01). Decedents in these NHs had reduced rates of depressive symptoms (OR, 0.191; P≤0.01), but not pain or hospitalizations. CONCLUSIONS: The intervention was not equally effective for all outcomes and facilities. As homes vary in their ability to adopt new care practices, and in their capacity to sustain them, reforms to create the environment in which effective palliative care can become broadly implemented are needed.
RCT Entities:
BACKGROUND: Deficits in end-of-life care in nursing homes (NHs) are reported, but the impact of palliative care teams (PCTeams) on resident outcomes remains largely untested. OBJECTIVE: Test the impact of PCTeams on end-of-life outcomes. RESEARCH DESIGN: Multicomponent strategy employing a randomized, 2-arm controlled trial with a difference-in-difference analysis, and a nonrandomized second control group to assess the intervention's placebo effect. SUBJECTS: In all, 25 New York State NHs completed the trial (5830 decedent residents) and 609 NHs were in the nonrandomized group (119,486 decedents). MEASURES: Four risk-adjusted outcome measures: place of death, number of hospitalizations, self-reported moderate-to-severe pain, and depressive symptoms. The Minimum Data Set, vital status files, staff surveys, and in-depth interviews were employed. For each outcome, a difference-in-difference model compared the pre-post intervention periods using logistic and Poisson regressions. RESULTS: Overall, we found no statistically significant effect of the intervention. However, independent analysis of the interview data found that only 6 of the 14 treatment facilities had continuously working PCTeams throughout the study period. Decedents in homes with working teams had significant reductions in the odds of in-hospital death compared to the other treatment [odds ratio (OR), 0.400; P<0.001), control (OR, 0.482; P<0.05), and nonrandomized control NHs (0.581; P<0.01). Decedents in these NHs had reduced rates of depressive symptoms (OR, 0.191; P≤0.01), but not pain or hospitalizations. CONCLUSIONS: The intervention was not equally effective for all outcomes and facilities. As homes vary in their ability to adopt new care practices, and in their capacity to sustain them, reforms to create the environment in which effective palliative care can become broadly implemented are needed.
Authors: Mary Pilar Ingle; Devon Check; Daniel Hogan Slack; Sarah H Cross; Natalie C Ernecoff; Daniel D Matlock; Dio Kavalieratos Journal: J Pain Symptom Manage Date: 2021-10-29 Impact factor: 3.612
Authors: Aluem Tark; Leah V Estrada; Mary E Tresgallo; Denise D Quigley; Patricia W Stone; Mansi Agarwal Journal: Palliat Med Date: 2020-03-10 Impact factor: 4.762
Authors: Lieve Van den Block; Elisabeth Honinx; Lara Pivodic; Rose Miranda; Bregje D Onwuteaka-Philipsen; Hein van Hout; H Roeline W Pasman; Mariska Oosterveld-Vlug; Maud Ten Koppel; Ruth Piers; Nele Van Den Noortgate; Yvonne Engels; Myrra Vernooij-Dassen; Jo Hockley; Katherine Froggatt; Sheila Payne; Katarzyna Szczerbinska; Marika Kylänen; Giovanni Gambassi; Sophie Pautex; Catherine Bassal; Stefanie De Buysser; Luc Deliens; Tinne Smets Journal: JAMA Intern Med Date: 2020-02-01 Impact factor: 21.873