Press Releases: National
Mar 21, 2008
Kaiser Permanente Study Links Hospital-based Palliative Care with Improved Quality and Higher Patient Satisfaction
Clinical Trial is first multi-center study to measure benefits of new medical model that puts patient values on par with a doctor's orders
A new Kaiser Permanente study is the first multi-center randomized trial to show hospital-based palliative care programs – which emphasize team-based supportive care for patients with advanced illness – result in improved quality of care including higher patient satisfaction, improved communication, and fewer ICU admissions. Given that only 30 percent of American hospitals offer palliative care programs, the study in the Journal of Palliative Medicine provides evidence to support expansion of these services nationwide.
Palliative care aims to relieve suffering and improve the quality of life for patients with advanced illnesses by emphasizing communication, managing pain and other symptoms, and addressing psychological, social, and spiritual needs.
"We sought to establish a high-quality palliative care program for our patients, but there was a lack of evidence-based models so we decided to conduct our own clinical trial to learn more about what works best," said lead study author Glenn Gade, MD, a Kaiser Permanente Colorado primary care physician. "Traditionally, there has been a physician-centric approach to care that focuses on treating the disease. Palliative care turns that model upside down by making the patient's wishes paramount and giving the family support from a multidisciplinary team that can help facilitate care that reflects the values of the patient and family."
The clinical trial was conducted among 512 patients with at least one life-threatening illness who received care at three Kaiser Permanente affiliated hospitals in Denver, Colo.; Portland, Ore.; and San Francisco in 2002 and 2003. One group of 275 patients received a palliative care intervention and 237 patients received usual care. The palliative care patients received continual consultation from a palliative care physician, nurse, hospital social worker, and chaplain to gauge their patient satisfaction, symptom management, psychosocial and spiritual support, end-of-life planning, and post-hospital care.
The study showed that patients who received palliative care were overall more satisfied with hospital care and provider communication. Specifically, patients in the palliative care intervention reported more positive feelings about pain management, symptom relief, psychological and social support, discharge planning and end-of-life planning. Additionally, they reported higher levels of caring, respect and understanding with their providers. Combined, these satisfaction, emotional, and communication measures suggest that patients in the palliative care intervention felt more in control, that they were being listened to and their wishes were taken seriously by the care team. Finally, the patients who received the palliative care had longer hospice lengths of stay, fewer ICU admissions, and completed more advanced directives. The study did not demonstrate differences in survival, symptom management, or some other aspects of emotional support.
According to Diane E. Meier, MD, director of the Center to Advance Palliative Care at the Mount Sinai School of Medicine in New York City, "This study adds to a critical mass of data suggesting that palliative care interventions – whether in the hospital or community setting – improve the quality of patient care, while making much better use of health care resources. Because palliative care is based on genuinely informed patient and family goals and preferences supported by continuity of care and 24/7 responsiveness to changing needs, these patients can stay safely at home and avoid unnecessary emergency room visits and hospitalizations. Palliative care is a win-win for everyone."
In 2006, as a result of these initial findings, Kaiser Permanente leadership requested that its affiliated hospitals nationwide implement palliative care services. The program, developed in Colorado by Kaiser Permanente and Exempla Saint Joseph Hospital, involves the most diverse team of caregivers and serves as the health plan's gold standard. Today, there are more than 35 Kaiser Permanente inpatient palliative care teams operating across the United States.
"Palliative care teams have the time to meet with patients and families to discover their view and values and support them in their decisions, plans, and hopes," said study co-author Richard Della Penna, MD, medical director, Kaiser Permanente Aging Network, and the National Elder Care Clinical Lead for Kaiser Permanente's Care Management Institute, which helps define standards of care for Kaiser Permanente physicians and members. "In today's rapid pace health care environment having the time to do this provides clinicians and patients with a rewarding and satisfying experience – and it is the right thing to do."
The study was funded by a grant from the Sidney R. Garfield Memorial Fund, which was established in 1987 to encourage innovation and exploration of new models of care that result in improved health care. The GMF funds research by Permanente physicians and Kaiser Permanente employees that will result in improved health care for both Kaiser Permanente members and the community at large.
About Kaiser Permanente
Kaiser Permanente is America's leading integrated health plan. Founded in 1945, it is a not-for-profit; group practice prepayment program headquartered in Oakland, Calif. Kaiser Permanente serves the health care needs of 8.7 million members in nine states and the District of Columbia. Today it encompasses the not-for-profit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 159,000 technical, administrative and clerical employees and caregivers, and more than 13,000 physicians representing all specialties. For more Kaiser Permanente news, visit the KP News Center at: http://xnet.kp.org/newscenter.
About Kaiser Permanente Research
Kaiser Permanente's eight research centers comprise one of the largest research programs in the U.S. and engage in work designed to improve the health of individuals everywhere. KP HealthConnect™, Kaiser Permanente's electronic health record, and other resources provide population data for research, and in turn, research findings arm KP physicians with up-to-the minute research and clinical data. Kaiser Permanente's research program works with national and local health agencies and community organizations to share and widely disseminate its research data. Kaiser Permanente's research program is funded in part by Kaiser Permanente's Community Benefit division, which in 2006 directed $808 million in health services, technology, and funding toward total community health.