Kaiser Permanente TriCentral Service Area Palliative Care Program Evaluation
The Home-Based Palliative Care Program (HBPC) at Kaiser Permanente (KP) TriCentral Service Area is an interdisciplinary home-based care program that provides home visits by physicians, nurses, social workers, and other health care professionals to terminally ill patients with an estimated life expectancy of one year and diagnoses of cancer, congestive heart failure, and/or chronic obstructive pulmonary disease. Provision of these services does not preclude the use of usual and customary services such as physician office services, specialty care, and the emergency department or inpatient care. Consistent with the Medicare Hospice benefit, the HBPC program provides a myriad of medical and supportive care within the patient’s home. This care includes extensive patient and family education on the disease or medical condition, training in symptom control, and psychosocial support aimed at assisting the patient and family in making care choices in advanced advance. The clinical structure of the HBPC parallels the Medicare hospice benefit with several important modifications. First, care is not limited to the last six months of life. Terminal patients served by the HBPC program may have a prognosis of 12 months or less to live as opposed to the hospice six-month life expectancy criteria. In addition, enrollment in the HBPC program does not entail forgoing curative care in exchange for palliative care. While a complete array of services are provided to the patient by the palliative care team, HBPC patients may continue to seek services, such as visits to their primary care physician, outside of HBPC. This allows HBPC patients access to a blended model of care, gradually decreasing curative practices and increasing palliative measures as their needs and desires shift.
Effectiveness of this model was studied with funding from the Kaiser Permanente Garfield Memorial Fund between 1999-2001. Patients enrolled in the Palliative Care Program comprised of a treatment group and were matched with a comparison group obtained from home health referrals of homebound patients with a diagnosis of COPD, CHF, or cancer, two or more emergency department visits or hospitalizations in the last year, and a prognosis of less than 24 months to live. Compared to the comparison group, Palliative Care patients had fewer Emergency Department visits, inpatient days, skilled nursing days, and physician office visits. However they had more home care visits than the comparison group.
