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A Multi-Site Replication of an Inpatient Palliative Care Program

18 Years
Not Enrolling
Cerebrovascular Accident, Cancer, Coronary Arteriosclerosis, Heart Failure, Congestive, Diabetes Mellitus, Acquired Immunodeficiency Syndrome, Failure to Thrive, Pulmonary Disease, Chronic Obstructive, Dementia, Kidney Failure, Chronic, Pneumonia, Liver Failure, Renal Failure, Respiratory Failure, Stroke

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Trial Information

A Multi-Site Replication of an Inpatient Palliative Care Program

The Inpatient Palliative Care Service (IPCS) was implemented at three Kaiser-Permanente
sites: Colorado, Portland and San Francisco. The service consisted of a physician, nurse,
social worker, and spiritual counselor who worked with the study subjects randomized to
receive the intervention. The intervention included symptom control, emotional and spiritual
support, advance care and post-discharge care planning, There were no differences in symptom
control or emotional support but IPCS patient reported better spiritual support compared to
usual care patients. IPCS patients also reported greater satisfaction with their hospital
care experience and better communication with their providers. Both IPCS and usual care
patients reported improved quality of life during their enrollment hospital stay. IPCS
patients completed more advance directives. IPCS patients had more home health visits than
usual care patients but significantly fewer ICU admissions. IPCS patients had significantly
lower hospital costs and higher pharmacy costs, than the usual care patients. IPCS patients
had significantly lower (p= .001) total health services costs (a cost savings of $64.90 per
patient per day) compared to usual care patients. This translated to an average total cost
savings of $3,185 per enrolled patient. IPCS patients had a significantly longer average
hospice length of stay. There were no differences between IPC and usual care patients in the
proportion admitted to hospice, time to hospice admission, the average length of survival,
or proportion of those who survived to 6 months.

Conclusion: IPCS resulted in better spiritual support, a better hospital care experience,
better communication with their providers, increased completion of advance directives, fewer
ICU admissions, longer hospice stays and reduced overall health care costs.

Inclusion Criteria:

Adults 18 years and older

-admitted to acute inpatient care who had: (1) a medical diagnosis which was
life-threatening, and (2) whose attending physician indicated they “would not be surprised
if the patient died within one year”.

Exclusion Criteria:

- 1) they had impaired cognitive status and no caregiver was available to provide
consent, (2) were currently enrolled in hospice or other studies involving palliative
care, (3) the attending physician did not approve study participation, or (4) their
medical condition impaired participation (actively dying, too ill to participate) and
no family member was available to provide consent.

Type of Study:


Study Design:

Allocation: Randomized, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Prevention

Outcome Measure:

Quality and cost of care

Principal Investigator

Ingrid M Venohr, RN, PhD

Investigator Role:

Study Director

Investigator Affiliation:

Kaiser Permanente


United States: Institutional Review Board

Study ID:

CO-02GGade-01 - H



Start Date:

April 2002

Completion Date:

July 2004

Related Keywords:

  • Cerebrovascular Accident
  • Cancer
  • Coronary Arteriosclerosis
  • Heart Failure, Congestive
  • Diabetes Mellitus
  • Acquired Immunodeficiency Syndrome
  • Failure to Thrive
  • Pulmonary Disease, Chronic Obstructive
  • Dementia
  • Kidney Failure, Chronic
  • Pneumonia
  • Liver Failure
  • Renal Failure
  • Respiratory Failure
  • Stroke
  • Palliative care
  • End of life care
  • Acquired Immunodeficiency Syndrome
  • HIV Infections
  • Arteriosclerosis
  • Chronic Disease
  • Coronary Artery Disease
  • Myocardial Ischemia
  • Dementia
  • Diabetes Mellitus
  • Failure to Thrive
  • Heart Failure
  • Immunologic Deficiency Syndromes
  • Kidney Failure, Chronic
  • Lung Diseases
  • Respiration Disorders
  • Pulmonary Disease, Chronic Obstructive
  • Pneumonia
  • Renal Insufficiency
  • Cerebral Infarction
  • Stroke
  • Liver Failure
  • Respiratory Insufficiency



Kaiser Permanente of ColoradoAurora, Colorado  80014