Expanding Access to Home-Based Palliative Care: A Randomized Controlled Trial Protocol.
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.
['Enguidanos|Susan|S|', 'Rahman|Anna|A|', 'Fields|Torrie|T|', 'Mack|Wendy|W|', 'Brumley|Richard|R|', 'Rabow|Michael|M|', 'Mert|Melissa|M|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002140:California D005260:Female D006333:Heart Failure D006699:Home Care Services D006801:Humans D008297:Male D008875:Middle Aged D009369:Neoplasms D017063:Outcome Assessment, Health Care D010166:Palliative Care D011320:Primary Health Care D029424:Pulmonary Disease, Chronic Obstructive
home-based palliative care randomized controlled trial primary care physician primary palliative care