Improving palliative care through teamwork (IMPACTT) in nursing homes: Study design and baseline findings |
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| Affiliation: | 1. Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY 14642, United States;2. Department of Medicine, Division of Palliative Care, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, United States;3. School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States;4. Department of Medicine, 100 Theory, Suite 100, University of California, Irvine 92697-1835, United States;1. Duke Clinical Research Institute, Department of Orthopaedic Surgery, Duke University, Durham, NC 27715, USA;2. Department of Medicine, Univ. of Florida, Gainesville, FL 32610, USA;3. Applied Physiology and Kinesiology, Univ. of Florida, Gainesville, FL 32611, USA;4. Biostatistics, Univ. of Florida, Gainesville, FL 32610, USA;5. Molecular Genetics and Microbiology, UF Genetics Institute, Univ. of Florida, Gainesville, FL 32610, USA;6. Department of Physical Therapy, Univ. of Florida, Gainesville, FL 32610, USA;7. School of Medicine, Saint Louis University, St. Louis, MO 63104, USA;8. Pain Research & Intervention Center of Excellence, Univ. of Florida, Gainesville, FL 32610, USA;1. Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;2. Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan;3. Department of Public Health, Health Management and Policy, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan |
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| Abstract: | BackgroundThe 2014 Institute of Medicine report recommended that healthcare providers caring for individuals with advanced illness have basic palliative care competencies in communication, inter-professional collaboration, and symptom management. Nursing homes, where one in three American decedents live and die, have fallen short of these competency goals. We implemented an intervention study to examine the efficacy of nursing home-based integrated palliative care teams in improving the quality of care processes and outcomes for residents at the end of life.Methods/designThis paper describes the design, rationale, and challenges of a two-arm randomized controlled trial of nursing home-based palliative care teams in 31 facilities. The impact of the intervention on residents' outcomes is measured with four risk-adjusted quality indicators: place of death (nursing home or hospital), number of hospitalizations, and self-reported pain and depression in the last 90-days of life. The effect of the intervention is also evaluated with regard to staff satisfaction and impact on care processes (e.g. palliative care competency, communication, coordination). Both secondary (e.g. the Minimum Data Set) and primary (e.g. staff surveys) data are employed to examine the effect of the intervention.DiscussionSeveral challenges in conducting a complex, nursing home-based intervention have been identified. While sustainability of the intervention without research funding is not clear, we surmise that without changes to the payment model that put palliative care services in this care setting on par with the more “skilled” care, it will not be reasonable to expect any widespread efforts to implement facility-based palliative care services. |
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