Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California.
Blue Shield of California, San Francisco, California.
J Palliat Med. 2019 Sep;22(S1):58-65. doi: 10.1089/jpm.2019.0147.
Studies show that home-based palliative care (HBPC) improves participant outcomes and satisfaction with care while also decreasing hospitalizations and emergency department visits. U.S. health care payment reforms create financial opportunities to offer HBPC. Consequently, more HBPC programs are emerging, heightening the need to evaluate their effectiveness. This randomized, controlled trial is comparing the effectiveness of an evidence-based model of HBPC and enhanced usual primary care for participants who receive primary care from medical groups and clinics organized under an accountable care organization or Medicare Advantage plan. Palliative care services are reimbursed by our partnering health plan provider. The five-year trial will enroll 1155 seriously ill participants (and ∼884 of their caregivers) with heart failure, chronic obstructive pulmonary disease, or advanced cancer. We are collecting data via telephone surveys with participants at baseline and one and two months postenrollment and with caregivers at baseline, one and two months postenrollments, and following the death of a loved one. We are collecting participant-reported outcome measures of pain, symptoms, anxiety, depression, participant-provider communication, and hope. Caregiver outcome measures include caregiver burden, communication with providers, anxiety, and depression. Additional outcomes are participant survival time and participants' emergency department visits and hospitalizations. Our research team has encountered several significant challenges in early study implementation. These include engaging primary care providers in the study and coordinating logistics with a health plan. Both challenges have contributed to a lag in participant enrollment. Despite these challenges, our study holds tremendous promise to accelerate adoption and spread of an evidence-based HBPC model across the country.
研究表明，居家姑息治疗（HBPC）可改善参与者的预后和对护理的满意度，同时减少住院和急诊就诊次数。美国医疗保健支付改革为提供 HBPC 创造了财务机会。因此，出现了更多的 HBPC 项目，这就需要对其效果进行评估。
这项随机对照试验正在比较基于证据的 HBPC 模型和强化常规初级保健对接受医疗集团和诊所提供的初级保健的参与者的有效性，这些医疗集团和诊所是根据问责制医疗组织或医疗保险优势计划组织的。姑息治疗服务由我们的合作健康计划提供者报销。这项为期五年的试验将招募 1155 名患有心力衰竭、慢性阻塞性肺疾病或晚期癌症的重病参与者（及其约 884 名护理人员）。我们通过电话调查收集参与者在基线和入组后一个月和两个月的数据，以及护理人员在基线、入组后一个月和两个月以及亲人去世后的数据。我们正在收集参与者报告的疼痛、症状、焦虑、抑郁、患者与提供者的沟通和希望等方面的结果测量数据。护理人员的结果测量包括护理人员负担、与提供者的沟通、焦虑和抑郁。其他结果包括参与者的生存时间以及参与者的急诊就诊和住院次数。
我们的研究团队在早期研究实施中遇到了几个重大挑战。这些挑战包括让初级保健提供者参与研究以及与健康计划协调后勤工作。这两个挑战都导致参与者入组滞后。尽管存在这些挑战，但我们的研究具有巨大的潜力，可以加速在全国范围内采用和推广基于证据的 HBPC 模式。
