Explore the primary research areas of the Enguídanos Lab:

The Home-based Palliative Care Model

Our research team developed and tested the HomePAL (home-based palliative care) model in two pivotal studies conducted in Kaiser Permanent HMOs in California, Colorado, and Hawaii. Both studies, published in 2002 and 2007, showed that, compared to usual care, HomePAL increased patient and caregiver satisfaction with medical care, decreased emergency department and hospital use, and increased rates of home deaths, in keeping with patient preferences.

The quality of our 2007 randomized controlled trial received the highest rating given in recent systematic reviews of palliative care models.  This trial, which enrolled 300+ seriously ill patients, found that patients who received HomePAL services had fewer emergency department visits, hospital inpatient days, skilled nursing days, and physician office visits (p<.001) than patients who received usual care. HomePAL patients, however, received more home visits.  When all service costs—for both inpatient and outpatient care as well as for the HomePAL services—were considered, total average costs for HomePAL patients were 37% to 45% lower than costs for patients receiving usual care.

Additional research demonstrated that seriously ill patients receiving HomePAL following hospital discharge were significantly less likely to be readmitted in the 30 days following discharge compared to patients discharged to home with usual care or discharged to a skilled nursing facility.

  • Analyzing Yelp Reviews of Nursing Homes: Lab faculty and research assistants are analyzing Yelp reviews of all nursing homes in California to identify which aspects of care are most important to nursing home residents and their families. They also are comparing nursing home Yelp ratings to the ratings on Nursing Home Compare, the ratings website administered by the federal Centers for Medicare & Medicaid Services.
  • Exploring Patient and Caregiver Views of Palliative Care: Nine individuals who have faced serious illness as either patients or caregivers serve as advisors and consultants to our PCORI study on “expanding access to community-based palliative care.” With their permission, we are sharing some of their experiences with and insights on palliative care as a strategy for promoting patient and caregiver engagement in the development of new palliative care programs.

Expanding Access to Home-based Palliative Care through Primary Care Medical Groups

Patients with serious illness arising from cancer, heart failure (HF), and chronic obstructive pulmonary disease (COPD) often receive poor quality of care, resulting in unmitigated pain and related symptoms, unmet psychosocial needs, and significant caregiver burden. Palliative care, a patient-centered approach that provides pain and symptom management and psychosocial and spiritual support, has strong evidence for improved outcomes for seriously ill patients. Similar to hospice care in its focus on comfort measures, palliative care differs from hospice in that it may be offered early in the course of an illness and in conjunction with other therapies intended to prolong life. Most palliative care programs are hospital-based; few offer care at home, where patients spend most of their time and require the most support.

We will compare outcomes from two groups: patients who receive primary palliative care (PPC), with usual care enhanced by provider training in palliative care, and patients who receive home-based palliative (HBPC) care provided by a primary care team. Seriously ill patients with cancer, HF, and COPD will be randomly assigned to either group.

The HBPC model will be integrated into primary care clinics. HBPC team members—a physician, nurse, social worker, and chaplain—will provide pain and symptom management, psychosocial and spiritual support, disease management education, and other services in response to patient and caregiver needs. Services are delivered at the patient’s home. The model also features a 24/7 call center.

Our study will determine whether HBPC, compared to PPC, results in greater reduction in patients’ pain, symptoms, depression, and anxiety, while improving hope and increasing survival. We also will determine whether HBPC is more effective in reducing emergency department visits and hospital stays, for these are often associated with preventable medical crises and increase anxiety and stress among patients and caregivers. We also will determine whether HBPC, compared to PPC, results in greater improvement in caregiver outcomes, including reduced depression, anxiety, and burden while improving caregivers’ experience during the patient’s last days of life.

Selected Publications

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