Replication of a Home-Based Palliative Care Program

Based upon the findings of the Palliative Care Study in the TriCentral Service Area, funding was sought to replicate the Home-Based Palliative Care (HBPC) Program to improve end-of-life care at two additional Kaiser Permanente (KP) sites. Health-care teams at KP sites in Colorado and Hawaii were chosen to initiate the Palliative Care Program and refine and adapt it as needed for successful implementation at each locale. The innovations of the Palliative Care Program have proven to be effective in providing patients with an appropriate level of care that coincide with their treatment decisions. While the evaluation design of the original TriCentral Palliative Care Program used a matched sample comparison group, randomization was employed in the replication study.

The specific aims of the project were twofold: 1) to test the ability to replicate the TriCentral Service Area’s Home-Based Palliative Care (HBPC) Program in two other sites and 2) to determine if implementation of the TriCentral Service Area’s Palliative Care Program at KP Health Plan of Colorado and KP Health Plan of Hawaii results in improved patient quality of life and satisfaction with care and reduced costs for end-of-life patients.

Patients randomized to in-home palliative care reported greater improvement in satisfaction with care at 30 and 90 days following 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 room (P =.013) or be admitted to the hospital than those receiving usual care (P <.001), resulting in significantly lower costs of care among intervention patients (P =.026). The Palliative Care Program is improving the quality of life for end-of-life patients and, while at the same time, stimulating cost effective change within the health care system to address the needs of those with chronic illness.