RESUMO
BACKGROUND: In response to a growing need for accessible, efficient, and effective palliative care services, we designed, implemented, and evaluated a novel palliative care at home (PC@H) model for people with serious illness that is centered around a community health worker, a registered nurse, and a social worker, with an advanced practice nurse and a physician for support. Our objectives were to measure the impact of receipt of PC@H on patient symptoms, quality of life, and healthcare utilization and costs. METHODS: We enrolled 136 patients with serious illness in this parallel, randomized controlled trial. Our primary outcome was change in symptom burden at 6 weeks. Secondary outcomes included change in symptom burden at 3 months, change in quality of life at 6 weeks and 3 months, estimated using a group t-test. In an exploratory aim, we examined the impact of PC@H on healthcare utilization and cost using a generalized linear model. RESULTS: PC@H resulted in a greater improvement in patient symptoms at 6 weeks (1.30 score improvement, n = 37) and 3 months (3.14 score improvement, n = 21) compared with controls. There were no differences in healthcare utilization and costs between the two groups. Unfortunately, due to the COVID-19 pandemic and a loss of funding, the trial was not able to be completed as originally intended. CONCLUSIONS: A palliative care at home model that leverages community health workers, registered nurses, and social workers as the primary deliverers of care may result in improved patient symptoms and quality of life compared with standard care. We did not demonstrate significant differences in healthcare utilization and cost associated with receipt of PC@H, likely due to inability to reach the intended sample size and insufficient statistical power, due to elements beyond the investigators' control such as the COVID-19 public health emergency and changes in grant funding.
RESUMO
According to the Centers for Disease Control and Prevention (CDC), more than 65 million adults in America have hypertension (HTN) and fewer than half of those 65 million people have their blood pressure (BP) under control. More than 1,000 deaths occur each day related to HTN and Americans are at an increased risk of complications related to uncontrolled BP such as heart failure, stroke, myocardial infarction, and kidney disease (). Data from the National Home and Hospice Survey, which is conducted by the CDC, indicate that 41% of home care patients have HTN (). This research brief column profiles four recently published articles on HTN. The first discusses the most recent guidelines for managing HTN, which were released in early 2014. The second article describes the success of an intensive structured HTN medication management and management protocol. The third and fourth briefs describe studies investigating the ongoing risk of HTN poststroke.
