Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Medicine, Dartmouth Health and the Geisel School of Medicine, Hanover, New Hampshire, USA.
J Am Geriatr Soc. 2024 Sep;72(9):2842-2852. doi: 10.1111/jgs.19022. Epub 2024 Jun 1.
In response to a growing need for accessible, efficient, and effective palliative care services, we designed, implemented, and evaluated a novel palliative care at home (PC@H) model for people with serious illness that is centered around a community health worker, a registered nurse, and a social worker, with an advanced practice nurse and a physician for support. Our objectives were to measure the impact of receipt of PC@H on patient symptoms, quality of life, and healthcare utilization and costs.
We enrolled 136 patients with serious illness in this parallel, randomized controlled trial. Our primary outcome was change in symptom burden at 6 weeks. Secondary outcomes included change in symptom burden at 3 months, change in quality of life at 6 weeks and 3 months, estimated using a group t-test. In an exploratory aim, we examined the impact of PC@H on healthcare utilization and cost using a generalized linear model.
PC@H resulted in a greater improvement in patient symptoms at 6 weeks (1.30 score improvement, n = 37) and 3 months (3.14 score improvement, n = 21) compared with controls. There were no differences in healthcare utilization and costs between the two groups. Unfortunately, due to the COVID-19 pandemic and a loss of funding, the trial was not able to be completed as originally intended.
A palliative care at home model that leverages community health workers, registered nurses, and social workers as the primary deliverers of care may result in improved patient symptoms and quality of life compared with standard care. We did not demonstrate significant differences in healthcare utilization and cost associated with receipt of PC@H, likely due to inability to reach the intended sample size and insufficient statistical power, due to elements beyond the investigators' control such as the COVID-19 public health emergency and changes in grant funding.
为满足对普及、高效和有效的姑息治疗服务日益增长的需求，我们设计、实施和评估了一种新型的居家姑息治疗（PC@H）模式，该模式以社区卫生工作者、注册护士和社会工作者为中心，辅以高级执业护士和医生提供支持。我们的目标是衡量接受 PC@H 对患者症状、生活质量和医疗保健利用和成本的影响。
我们将 136 名患有严重疾病的患者纳入这项平行、随机对照试验。我们的主要结局是 6 周时症状负担的变化。次要结局包括 6 周和 3 个月时生活质量的变化，使用组 t 检验进行评估。在一项探索性目标中，我们使用广义线性模型检查了 PC@H 对医疗保健利用和成本的影响。
与对照组相比，PC@H 在 6 周（改善 1.30 分，n=37）和 3 个月（改善 3.14 分，n=21）时患者症状的改善更大。两组之间的医疗保健利用和成本没有差异。不幸的是，由于 COVID-19 大流行和资金损失，该试验无法按原计划完成。
利用社区卫生工作者、注册护士和社会工作者作为主要护理提供者的居家姑息治疗模式可能会改善患者的症状和生活质量，与标准护理相比。我们没有证明与接受 PC@H 相关的医疗保健利用和成本有显著差异，这可能是由于无法达到预期的样本量和统计能力不足，这是由于 COVID-19 公共卫生紧急情况和赠款资金变化等调查人员无法控制的因素造成的。
