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Program Evaluation of an Outpatient Palliative Care Model

Jackson, Molly
http://orcid.org/0000-0002-8652-3034
http://rave.ohiolink.edu/etdc/view?acc_num=casednp1430830260

Abstract Details

2015, Doctor of Nursing Practice , Case Western Reserve University, School of Nursing.
Abstract Americans are living longer than ever, and with a greater number of comorbid conditions. In 2012 there were approximately 90 million Americans living with serious illness and this number is expected to double in the next 25 years (http://www.dartmouthatlas.org/data/topic/topic.aspx?cat=1). Palliative care consulting services have been initiated in many urban hospital settings with evidence of benefits for patients in terms of symptom management, and goal-directed care (Meier, Isaacs, & Hughes 2010). Additionally, outpatient programs providing palliative care to patients diagnosed with cancer have been described in the literature (Jackson, 2013; Teno, Gonzalo, Bynum, Leland, Miller, …& Morrison, 2013; Zimmerman, Swami, Krzyanowska, Hannon, Leighl, Oza, … & Lo, 2014). Little is known, however, about the impact of providing palliative care in home settings to clients with non-cancer diagnoses. The purpose of this study is to describe an evaluation of a home-based palliative care pilot program developed as a partnership between administrators of an adult-living community and a palliative-care consult team. The evaluation covered a period of one year from December 2012 to December 2013. The program evaluation addresses the following questions: What was the impact of early palliative care related to unplanned hospitalizations and emergency department visits as compared to patients receiving standard palliative care? What was the impact of early palliative care relating to advance care planning as compared with patients receiving standard palliative care? What was the impact of early palliative care relating to the number of advanced practice nursing visits and social work visits as compared to patients receiving standard palliative care? Was there a difference in client satisfaction between the two groups? The Centers for Disease Control and Prevention’s Framework for Program Evaluation in Public Health model was used to evaluate the pilot initiative (Yarbrough, Shulha, Hopson, & Caruthers, 2011). Twenty-nine clients in the pilot group were matched with a comparison group of 29 clients receiving standard palliative care. Quantitative data were collected by means of electronic medical record review and survey analysis. Group differences were assessed using chi-square and Mann-Whitney tests. Median emergency department visits were 1.00 in the pilot group compared to 0.00 in the standard care group. There were no statistical differences in hospitalizations or in rates of completed advance directives. The pilot group received significantly more social work visits (Mdn=5) than the standard palliative care group (Mdn=1). Advanced practice nurse visits between groups were not significantly different with a median number of three visits each. Limitations of the program evaluation include a small pilot sample size (N=29), inability to estimate program costs, possible comparison group selection bias, and a lack of generalizability. More study is needed to see whether this model is effective and can be applicable to other settings.
Barbara Daly, PhD, RN, FAAN (Committee Chair)
62 p.
Nursing
advance care planning; advanced practice nurse; outpatient palliative care; program evaluation; social work

Recommended Citations

Citations

  • Jackson, M. (2015). Program Evaluation of an Outpatient Palliative Care Model [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1430830260

    APA Style (7th edition)

  • Jackson, Molly. Program Evaluation of an Outpatient Palliative Care Model. 2015. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=casednp1430830260.

    MLA Style (8th edition)

  • Jackson, Molly. "Program Evaluation of an Outpatient Palliative Care Model." Doctoral dissertation, Case Western Reserve University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1430830260

    Chicago Manual of Style (17th edition)

casednp1430830260
212
© 2015, some rights reserved.Creative Commons License Program Evaluation of an Outpatient Palliative Care Model by Molly Jackson is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. Based on a work at etd.ohiolink.edu.
This open access ETD is published by Case Western Reserve University Doctor of Nursing Practice and OhioLINK.