Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #113622

Deborah D. Riopelle, MSPH¹, Alla Sverdlik, MPH², M. Jillisa Steckart, MEd, PsyD³, Glenn J. Wagner, PhD⁴, and Kenneth E. Rosenfeld, MD³. (1) Research & Development Service, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Bldg. 304, rm. E3-110, Los Angeles, CA 90073, 310-478-3711, x48142, Deborah.Riopelle@med.va.gov, (2) Veterans' Integrated Palliative Care Program, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, (3) Palliative Care Program, Veterans Administration Greater Los Angeles Healthcare System (VA-GLAHS), 11301 Wilshire Boulevard, 111-G, Los Angeles, CA 90073, (4) RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138

Objective: The long-term goal of this study is to improve the quality of end-of-life care for veterans by evaluating a model of patient-centered palliative care that incorporates early case finding and nurse care management services. This presentation will report on findings related to study enrollment and retention and discuss the implication of study results for structuring delivery and evaluation of palliative care services for veterans. Methods: Potential study participants are identified from all patients admitted to the general medical service at one VA hospital during a 20-month enrollment period and who the admitting resident estimates to have at least a 25% one-year mortality risk. Exclusion criteria include cognitive impairment and other factors that would make it impossible to conduct follow up interviews and to provide care management services. Following a baseline interview, eligible consented patients are randomized to usual care (control) or to palliative evaluation followed by post-discharge nurse care management (intervention). Longitudinal patient and caregiver interviews assess treatment preferences, quality of life, satisfaction with care, and other relevant outcomes. After death interviews with caregivers assess quality of the patients' dying experiences. Results: Preliminary data analyses included 1,172 unique admissions of which 358 (30.5%) were eligible for study participation based on prognostication. Fifty-six percent of eligible patients were excluded based on predetermined exclusion criteria including: admission from a nursing home or hospice (25%), probable discharge to a nursing home or hospice (17%), inability to pass the cognitive screen (16%), and homeless or lack of a telephone (15%). After six months of enrollment, 18 (28.5%) of 63 patients enrolled for three or more months had died. Median number of days after enrollment for patient deaths was 47. Discussion: Choice of methods for case finding, exclusion of patients, and data collection has important implications for evaluation of palliative care programs. A close match between study design and service structure will assure optimal service delivery and evaluation effectiveness.

Learning Objectives: At the conclusion of this presentation, the participant will be able to

• Identify potential inclusion and exclusion criteria and screening methods for evaluation study participation.
• Identify major barriers to enrolling patients and their caregivers in a palliative care evaluation study.
• Discuss practical approaches to increasing evaluation study participation by patients and their caregivers.

Keywords: End-of-Life Care, Evaluation

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.