Study to Improve Care for Veterans During Serious Illness

NCT00106041 | Completed

• 1 other identifier: IIR 02-294
• Study Type: interventional
• Target: 400
• Locations: 1 country
• Sites: 1

Brief Summary

Improving end-of-life care is of critical importance to the VA as it faces an increasingly aging and dying veteran population. Previous work within and outside of the VA has demonstrated serious deficiencies in the quality of care delivered near the end of life. Moreover, veterans in the VA system suffer from a higher rate of chronic and life-limiting illnesses and decrements in health-related quality of life compared with the age-matched controls. In FY2000 approximately 104,000 enrolled veterans died in the U.S. including 27,200 that died as inpatients in VA acute or chronic care medical wards. The care model on which the proposed study is based is theoretically sound and has been piloted in a study that suggested its use can help the VA achieve substantial quality improvement at reduced costs.

Conditions

Palliative Care

Keywords

end of life care; evaluation studies; quality of death and dying; palliative care; coordination of care; satisfaction with care; healthcare cost; utilization of healthcare resources; caregivers; veterans

Outcome Measures

Primary Outcomes (1)

• Healthcare expenditures including inpatient, ICU, outpatient, pharmacy and total costs; utilization of healthcare resources; and quality of death and dying experience. Includes expenditures time of study enrollment until patient's death.

  We will be tracking resource use until the death of the patient or the conclusion of the study, whichever comes first. Quality of the death and dying experience will be assessed within 90 days of death

Secondary Outcomes (1)

• Satisfaction with care, quality of care, symptom management, understanding of illness, continuity and coordination of care, end-of-life care preferences, advance care planning, and treatments.

  This will be assessed during the first year of enrollment.

Study Arms (1)

Arm 1

OTHER

Palliative Care Nurse Case Management

Behavioral: Veterans Integrated Palliative Care Nurse Case Manager

Interventions

Veterans Integrated Palliative Care Nurse Case Manager BEHAVIORAL

Palliative Care nurse case management

Arm 1

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• All patients admitted to the hospital's general medicine service and estimated to have at least a 25% risk of dying over the following year.

You may not qualify if:

• Inability to pass cognitive screen
• Homelessness
• No telephone
• Admission from or discharge to a nursing home or hospice care
• Enrollment in another healthcare program or study that duplicates services of this study
• Receives most healthcare/primary healthcare services outside the VA GLA catchment area
• Does not speak English

Sponsors & Collaborators

• US Department of Veterans Affairs: lead

Study Sites (1)

VA Greater Los Angeles Healthcare System, West Los Angeles, CA

West Los Angeles, California, 90073, United States

Location

Related Publications (9)

• Wagner GJ, Riopelle D, Steckart J, Lorenz KA, Rosenfeld KE. Provider communication and patient understanding of life-limiting illness and their relationship to patient communication of treatment preferences. J Pain Symptom Manage. 2010 Mar;39(3):527-34. doi: 10.1016/j.jpainsymman.2009.07.012. Epub 2010 Feb 19.

  PMID: 20171827 RESULT

• Seow H, Snyder CF, Shugarman LR, Mularski RA, Kutner JS, Lorenz KA, Wu AW, Dy SM. Developing quality indicators for cancer end-of-life care: proceedings from a national symposium. Cancer. 2009 Sep 1;115(17):3820-9. doi: 10.1002/cncr.24439.

  PMID: 19514090 RESULT

• Goebel JR, Doering LV, Lorenz KA, Maliski SL, Nyamathi AM, Evangelista LS. Caring for special populations: total pain theory in advanced heart failure: applications to research and practice. Nurs Forum. 2009 Jul-Sep;44(3):175-85. doi: 10.1111/j.1744-6198.2009.00140.x.

  PMID: 19691653 RESULT

• Fromme EK, Hughes MT, Brokaw FC, Rosenfeld KE, Arnold RM. Update in palliative medicine 2008. Journal of palliative medicine. 2008 Jun 1; 11(5):769-75.

  RESULT

• Casarett D, Pickard A, Amos Bailey F, Ritchie C, Furman C, Rosenfeld K, Shreve S, Shea JA. Important aspects of end-of-life care among veterans: implications for measurement and quality improvement. J Pain Symptom Manage. 2008 Feb;35(2):115-25. doi: 10.1016/j.jpainsymman.2007.03.008. Epub 2007 Nov 28.

  PMID: 18053680 RESULT

• Lorenz KA, Lynn J, Dy SM, Shugarman LR, Wilkinson A, Mularski RA, Morton SC, Hughes RG, Hilton LK, Maglione M, Rhodes SL, Rolon C, Sun VC, Shekelle PG. Evidence for improving palliative care at the end of life: a systematic review. Ann Intern Med. 2008 Jan 15;148(2):147-59. doi: 10.7326/0003-4819-148-2-200801150-00010.

  PMID: 18195339 RESULT

• Lorenz KA, Rosenfeld K, Wenger N. Quality indicators for palliative and end-of-life care in vulnerable elders. J Am Geriatr Soc. 2007 Oct;55 Suppl 2:S318-26. doi: 10.1111/j.1532-5415.2007.01338.x. No abstract available.

  PMID: 17910553 RESULT

• Chang VT, Sorger B, Rosenfeld KE, Lorenz KA, Bailey AF, Bui T, Weinberger L, Montagnini M. Pain and palliative medicine. J Rehabil Res Dev. 2007;44(2):279-94. doi: 10.1682/jrrd.2006.06.0067.

  PMID: 17551879 RESULT

• Krouse RS, Mohler MJ, Wendel CS, Grant M, Baldwin CM, Rawl SM, McCorkle R, Rosenfeld KE, Ko CY, Schmidt CM, Coons SJ. The VA Ostomy Health-Related Quality of Life Study: objectives, methods, and patient sample. Curr Med Res Opin. 2006 Apr;22(4):781-91. doi: 10.1185/030079906X96380.

  PMID: 16684439 RESULT

Study Officials

• Kenneth E. Rosenfeld, MD

  VA Greater Los Angeles Healthcare System, West Los Angeles, CA

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 18, 2005
• First Posted: March 21, 2005
• Study Start: August 1, 2004
• Primary Completion: November 1, 2007
• Study Completion: September 1, 2012
• Last Updated: April 7, 2015

Record last verified: 2012-09

Locations

US (1)