Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：为了应对不断增长的可访问需求，高效,和有效的姑息治疗服务，我们设计的,已实施，并评估了以社区卫生工作者为中心的严重疾病患者的新型家庭姑息治疗（PC@H）模型，注册护士,一个社会工作者,有先进的执业护士和医生的支持。我们的目标是测量接受PC@H对患者症状的影响，生活质量,以及医疗保健利用率和成本。
方法：我们平行招募了136名患有严重疾病的患者，随机对照试验。我们的主要结果是6周时症状负担的变化。次要结果包括3个月时症状负担的变化，6周和3个月时生活质量的变化，使用组t检验估计。在探索性目标中，我们使用广义线性模型研究了PC@H对医疗保健利用率和成本的影响。
结果：PC@H导致6周时患者症状有更大的改善（1.30分改善，n=37)和3个月(3.14分改善，n=21）与对照组相比。两组之间的医疗保健利用率和成本没有差异。不幸的是,由于COVID-19大流行和资金的损失，试验未能如原计划那样完成.
结论：利用社区卫生工作者的家庭姑息治疗模式，注册护士,与标准护理相比，社会工作者作为主要的护理提供者可能会改善患者的症状和生活质量。我们没有表现出与收到PC@H相关的医疗保健利用率和成本的显著差异，可能是由于无法达到预期的样本量和统计能力不足，由于调查人员无法控制的因素，如COVID-19公共卫生紧急情况和赠款资金的变化。
方法：我们平行招募了136名患有严重疾病的患者，随机对照试验。我们的主要结果是6周时症状负担的变化。次要结果包括3个月时症状负担的变化，6周和3个月时生活质量的变化，使用组t检验估计。在探索性目标中，我们使用广义线性模型研究了PC@H对医疗保健利用率和成本的影响。
结果：PC@H导致6周时患者症状有更大的改善（1.30分改善，n=37)和3个月(3.14分改善，n=21）与对照组相比。两组之间的医疗保健利用率和成本没有差异。不幸的是,由于COVID-19大流行和资金的损失，试验未能如原计划那样完成.
结论：利用社区卫生工作者的家庭姑息治疗模式，注册护士,与标准护理相比，社会工作者作为主要的护理提供者可能会改善患者的症状和生活质量。我们没有表现出与收到PC@H相关的医疗保健利用率和成本的显著差异，可能是由于无法达到预期的样本量和统计能力不足，由于调查人员无法控制的因素，如COVID-19公共卫生紧急情况和赠款资金的变化。
