Inpatient vs. home care: A pilot hospice comparative effectiveness study
Background: Despite recent advances in advance care planning and patient education, half of patients with cancer enroll in hospice in the last 3 weeks of life, and one third enroll in the last week. These patients and their families don’t benefit fully from hospice services including symptom management, home care, nursing, spiritual and emotional support, practical assistance, and counseling. Although inpatient hospice care offers a promising way to better meet the needs of these patients and their families, little is known about the effectiveness of inpatient hospice units.
Objectives: The overarching goals of this pilot project are to explore the potential benefits of inpatient care for patients who are referred to hospice in the last week of life, and to lay the foundation for a future large-scale study that will determine whether inpatient care is beneficial, and cost-effective. Specifically, the objectives of this project are to explore the effects of inpatient care on quality and family satisfaction, and to identify subgroups of patients and families who are most likely to benefit from inpatient care.
Aims: 1) To establish the validity of quality measures abstracted from hospice Electronic Health Records (EHRs); 2) To establish the feasibility of linking EHR data with family satisfaction data (Family Evaluation of Hospice Care survey results); 3) To define plausible effect sizes for the impact of inpatient hospice care on accepted quality measures and family satisfaction; 4) To obtain input from the CHOICE community of hospices regarding the selection of quality measures and FEHC items that should be the focus of future research.
David Casarett MD MA completed his medical training at Case Western Reserve University in 1993, and his internship and residency in internal medicine at the University of Iowa in 1996. His additional training has included a Master’s degree in medical anthropology at CWRU, and fellowships in ethics at the University of Chicago and in Palliative Medicine at the University of Pennsylvania. He has worked as a hospice medical director and is currently an Assistant Professor in the Division of Geriatric Medicine at the University of Pennsylvania. He is also a staff physician at the Philadelphia VAMC, where he is the medical director of the palliative care service, and is on the faculty of the Center for Health Equity Research and Promotion. Dr. Casarett is board certified in Internal Medicine and Palliative Medicine, and is a Fellow of the American Academy of Hospice and Palliative Medicine.
Dr. Casarett’s major research interest is understanding and improving the way that patients near the end of life and their families make medical decisions. His work in this area has included epidemiological studies of referral to hospice and utilization of alternatives to hospice, studies of decision-making about end of life care, and a randomized controlled trial of an intervention to promote earlier hospice referrals in nursing homes. Dr. Casarett is also the PI of federally funded studies to assess the quality of end-of-life care in the VA health care system, and to improve access to high-quality end of life care for patients with cancer.
Dr. Casarett’s research has been funded by the Department of Veterans Affairs, by a Paul Beeson Physician Faculty Scholars Award, and by other grants from the National Institutes of Health, the Hartford Foundation, and the Greenwall Foundation.