Background of the Study
The article involves a quantitative study carried out to determine the effectiveness of a home-based palliative program for end-of-life care. The study observed how the need to improve healthcare for Americans in their senior years has gained increased focus in the past decade. It has noted how the baby boomers have joined the elderly population in large numbers which has increase burden to the healthcare system. The population in United States is estimated to be comprised of about 12.5% of the old population and with this number expected to be on the rise. It is estimated the less than 5% of the Medicare die annually, but the medical costs for the last year of life for this group amounts to 25% of the total annual costs. The clinical problem addressed by this article is on how the current constraints put in place by Medicare regulations have created barriers to developing modes of palliative care for the terminally and chronically ill patients (Brumley, Enguidanos, & Hillary, 2003).
The significance of the study is noted by indicating how the barriers associated with Medicare regulations and other barriers such as patients refusing hospice care, uncertainty in establishing life expectancy of the patients, patients’ unwillingness of undertaking curative care and negative image of hospice care contributes to patient’s care while in acute care units and intensive care unit even after receiving medically futile care. This significance is elaborated using statistics that indicated that in South California TriCentral Area 63% of patients in ICU and 54% of those who died in medical or surgical units had terminal or chronic illness (Brumley, et al., 2003).
The purpose of the study was to establish the effectiveness TriCentral Palliative Care Program, which is an end-of-life care plan, and establish how the help serve the patients better. The research question that the study aims to achieve is on “Are palliative care patients more satisfied with the TriCentral Palliative Care Program and thereby lead to use of fewer medical service as compared to patients receiving the traditional end-of-life?” The purpose of the study and its research problem are connected. While the purpose of the study intended to establish the effectiveness of the TCPC program, the research question offered a means of establishing this effectiveness by seeking to make a comparison of patients’ satisfaction level using either the TCPC or the traditional end-of-life program.
Methods of the Study
The study design adopted for the study included a nonequivalent comparison group design where data from the control group was compared with that of the intervention group. The importance of engaging in this study was noted the be associated with the facilitation of the process of evaluation how the program achieved complex physical, emotional, social and spiritual need of end-of-life patients. The study was approved by the Kaiser Permanente Southern California Human Subject Protection Committee. It is clear that the study was through voluntary participation as patients have the option of declining where it is noted that 73 eligible patients declined being interviewed (Brumley, et al., 2003).
Data was collected through phone interviews seven days after enrollment and 60 minutes thereafter. The main variables data gathered for the study included demographic data, patient’s rating of their illness severity, quality of life, and satisfaction of services offered. The satisfaction data was collected using the Reid-Gundlach Satisfaction instruments and yielded three categories where overall satisfaction was measured. Service utilization data was gathered from KP administrative databases. The costs effectiveness of the program was measured by evaluation of the staff costs only.
Part of data management process for the study involved organizing the intervention and comparison group in a manner that data from each group would be comparable. This was achieved by putting in place selection criterion that ensured comparison among groups of patients at end-of-life. Data analysis included the use of post hoc students t-tests for individual dependent variable to establish group differences. Multiple regression was used to establish the portion of costs that could be explained by control group. The rigor of the process was assured through the use of statistical software such SPSS statistical software and LIMDEP data analysis software package. Reduction of the research bias was carried out through the control of statistically significant between group differences were controlled as covariates. Multivariate analysis variance (MANCOVA) was used to control Type I error associated with multiple tests (Brumley, et al., 2003).
Results of Study
Results on high patient satisfaction indicated absence of any statistical significance in mean satisfaction scores between intervention and comparison groups. It was observed that at baseline, the satisfaction was high for both groups. After 60 days enrollment the satisfaction level among the intervention group increased significantly from baseline while that of comparison group remained the same (Brumley, et al., 2003). More patients were found to die among the intervention group in comparison to control group. The results on effective cost management indicated that among the intervention group there were fewer emergency department visits, inpatients days, skilled nursing days, and physician office visits relative to the comparison groups. However, the intervention group had more care visits than the comparison groups. There was cost reduction across diagnoses but more significant for patients with cancer.
The results of this study pointed to the fact that enrollment of care model produced lower costs of care and higher patient satisfaction relative to the traditional care. The findings can be said to be an accurate reflection of reality based on the fact that the TCPC program was an innovative program designed to offer healthcare services to chronically and terminally ill patients. This implied that the program was structured to specifically the needs of these patients by ensuring the gradual transition from curative focus to increasing palliative measure. The study was found to have huge implications for healthcare practice. The study identified that the model being analyzed caused a 45% decrease in cost of services offered to palliative care patients (Brumley, et al., 2003). The study also pointed to how end-of-life was not a preference among patients which saw most patients die in hospitals despite their wish to die at home. The program analyzed offers an ethical alternative to traditional end-of-life care for nurse’s practitioners to apply in a manner that allows the patients an opportunity to die without pain and yet in comfort of their own home. The results in the reduced need of for specialized care among the patients using TCPC program and high satisfaction levels offers a recommendation that care can effectively be transferred from hospital setting to home environment. An unexcepted benefit that could affect the nursing practice was on increased heightened consciousness and acquisition of enhanced end-of-life skills by health care practitioners (Brumley, et al., 2003).
One limitation of the study was found to be on its research design which did not offer an exhaustive means of testing the model. The possibility of generalizing the model to others sites was found to be limited because the study took place in closed system with sample acquired only from South Carolina. The article indicated the need of using randomized studies in the testing of the model and offering more strengthening the validity of the findings. The article indicated the need for multisite studies to evaluate the generalizability of the model to other systems and populations. The article was presented in a logical coherent logic with results progressively building on each other.
The study was approved by the Kaiser Permanente Southern California Human Subject Protection Committee. The article does not specify how the patient privacy was protected. The only ethical consideration regarding the treatment indicated was on voluntary participation. This can be observed from the fact that for the study 558 participants were enrolled from which 73 eligible patients declined the engage in the study (Brumley, et al., 2003).
The thesis statement indicated that palliative care patients using the TriCentral Palliative Care (TCPC) would be more satisfied with their healthcare and use less medical services than the patients receiving traditional end-of-life medical care. This thesis statement indicates an innovative approach meant overcome the barriers associated with Medicare regulations and other barriers associated with the traditional palliative care. The TCPC program being assesses is an interdisciplinary home-based program for patients at end of life. It offers enhanced pain control, symptom management, and psychosocial support with an aim of improving the quality of life and care and thereby reduce the total costs of care. The study was carried out through a non-equivalent comparison group design where the patients the intervention group were subjected to TSPC program and the control group with the traditional end-of-life care. The results of this study pointed to the fact that enrollment of care model produced lower costs of care and higher patient satisfaction relative to the traditional care. The program represented how end of life care should experience gradual transition from curative focus to increasing palliative measure. This study has implication in nursing practice in that it provides an end-of-life program with capability of reducing cost by 45%, offers an ethical alternative to traditional end-of-life care for nurses’ practitioners to apply, points out to the fact that the palliative care can be transferred from hospital to home environment thereby improving satisfaction, and the program offers an opportunity for healthcare practitioners to improve their skills on palliative care.
Brumley, R., Enguidanos, S., & Hillary, K. (2003). Effectiveness of Home-Based Palliative Care Program for End-of-Life. Journal of Palliative Medicine, 715-724.
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