Feasibility of a Home-Based Palliative Care Intervention for Elderly Multimorbid Survivors of Critical Illness.
Florian B Mayr, Judith L Plowman, Sandra Blakowski and 3 others
PMID 33385209WHAT IT FOUND
Fifteen elderly ICU survivors were enrolled in home palliative care; 11 completed all visits.
Symptom scores and ED visits were observed, not tested, so this cannot show the intervention worked.
Key findings
01Fifteen patients were enrolled over 12 months, and 11 (73%) completed all study visits.
02Among the 11 patients who completed all visits, median sESAS symptom score was 3 at day 90 versus 4 initially, and no formal statistical testing was done.
03Median hospital admissions during the project were 1 versus 1 in the preceding 3-month period, and median unplanned ED visits were 1 versus 2.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study enrolled only 15 patients, all male Veterans, so it cannot estimate how well this model would work in a larger or more diverse group. It was a quality-improvement feasibility project, and the authors did not perform formal statistical testing, so the day-90 scores, readmissions, and ED visits are descriptive. Clinical outcome medians are reported for the 11 patients who completed all visits, not for all 15 patients. The first home visit took a median of 8 days, although the planned target was within 72 hours of discharge. Two patients died before study completion and two missed visits because of early complicated rehospitalizations, so completion was not universal. The setting was the largest integrated healthcare system, so staffing, costs, and outcomes may not transfer to other systems. The authors estimated cost using billing codes and did not do a formal cost-benefit analysis. Caregiver satisfaction was not evaluated.
Declared interests
The supplied text lists research support from NIH extramural and U.S. Government non-P.H.S. sources; it does not provide author financial disclosures.
The easy way to misread this
Do not read the lower median ED visits (1 versus 2) or slightly better symptom scores as proof the program works. The study enrolled 15 patients, reported outcomes for the 11 who completed all visits, and used no formal statistical testing.