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Emergency department-initiated palliative care in older adults with advanced illness
Investigator (PI): Grudzen, Corita R
Performing Organization (PO): (Current): New York University, NYU Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine / (212) 562-6561
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2017
Final Year: 2023
Record Source/Award ID: PCORI/PLC-1609-36306
Funding: Total Award Amount: $12,243,681
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Half of older Americans visit the emergency department (ED) in the last month of life, making the ED a key decision point when doctors and nurses work with patients and families to establish a plan of care going forward. Palliative care interventions in the ED can both capture high risk patients at a time of crisis and dramatically improve patient-centered outcomes by providing an extra layer of support for older adults and their caregivers. By testing novel models of care that can be delivered more efficiently, we can build on the effectiveness of specialty palliative care demonstrated in ED patients admitted to the hospital. This proposal will generate comparative effectiveness research evidence to support the delivery of coordinated, community-based palliative care that effectively implements care plans that are consistent with the goals and preferences of older adults with advanced illness and their caregivers. We propose a large, multisite study based in nine emergency departments (EDs) across the country to understand which model of palliative care in the community improves patient- and family-centered outcomes. The study will recruit a geographically, racially, and ethnically diverse group of older adults living at home with advanced cancer or end-stage organ failure, and their caregivers, upon visiting the ED. We will compare two established palliative care models: nurse led telephonic case management and specialty, outpatient palliative care. The models vary on the level of integration with patients' other providers and whether palliative care is delivered via the outpatient clinic or at home, and in-person versus by telephone. We will measure and evaluate patient- and caregiver-centered outcomes as our primary and secondary end points, including quality of life, health care use, loneliness, and burden on caregivers. The proposal has strong endorsement and study participation from patient and organizational representatives, as well as a large Medicare Advantage plan that has implemented the nurse led telephonic model on which one arm of the study is based. Specifically, we will answer the following important question: When caring for older adults with serious, life limiting illness discharged home after an ED visit, how effectively does nurse led telephonic case management enhance quality of life and reduce health care use, loneliness, and burden on caregivers when compared with facilitated outpatient specialty palliative care?
MeSH Terms:
  • Aged
  • Caregivers
  • Comparative Effectiveness Research
  • Emergency Service, Hospital /*organization & administration
  • Ethnic Groups
  • Geography
  • Humans
  • Medicare Part C
  • Models, Organizational
  • Nursing
  • Outcome Assessment, Health Care
  • Outpatients
  • Palliative Care /*organization & administration
  • Patient-Centered Care
  • Program Development
  • Quality of Life
  • Telemedicine /methods
  • Terminal Care /*organization & administration
  • United States
Country: United States
State: New York
Zip Code: 10016
UI: 20181691
CTgovId: NCT03325985
Project Status: Ongoing
Record History: ('2018: Project extended to 2023.',)