1. A Systematic review of the effectiveness of structured interdisciplinary collaboration for adult home hospice/palliative care patients on patient satisfaction and hospital admissions and re-admission
Durline Brown-Manhertz, MS, RN, FNP-BC, DNPc1, Rincy Joseph, MS, RN, FNP-BC, NP-C, DNPc1, Stella Ikwuazom, MS, RN, FNP-BC, NP-C, CCRN, DNPc1, Michelle Santomassino, DNP, RN, FNP-BC2, Joanne K Singleton, PhD, RN, FNP-BC, FNAP, FNYAM 2
JBI Library of Systematic Reviews. 2014;12(7) 148 – 163, College of Health Professions, Pace University, New York, NY
RESULTS
RESEARCH QUESTIONS
DISCUSSION
What is the effectiveness of structured interdisciplinary collaboration versus usual care on patient satisfaction with services in adults receiving home hospice/ palliative services?
What is the effectiveness of structured interdisciplinary collaboration versus usual care on hospital admission and re-admission rates for adults receiving home hospice/palliative services?
A total of two articles; one randomized controlled trial and one quasi experimental were included. Both studies evaluated and found increased patient satisfaction and decreased emergency department and hospital visits in palliative care patients in homecare settings. The RCT showed a statistically significant difference in patient satisfaction at 90 days follow up (93.4% intervention, 80.8% control). Palliative care patients utilized emergency department services less frequently than usual care participants ( 20% vs 33%, P=.01). The palliative care enrollees resulted in fewer hospital days by 4.36 (P<.001; R squared=.014). The quasi-experimental study showed a higher patient satisfaction in the intervention group at 60 days (t=-2.57; P= 0.01). Satisfaction at 60 days in the usual care group remained the same (t=-.05; p=0.6The palliative care group showed significantly fewer emergency department visits (F=21.059; P<0.001) ) and fewer hospital days (F=29.011; P<0.001).
Home hospice/palliative care service requires incorporation of interdisciplinary-based approaches to healthcare that are fundamental to the patient’s ability to achieve optimal health goals.
A successful collaborative team approach may have had an impact on both the quality of patient care as well as the experience of patients and families.
Coordination of care from the interdisciplinary team led to improved patient satisfaction and prevented conditions that may have resulted in excessive hospital admissions.
In the home hospice/palliative care settings, interdisciplinary collaboration among care teams as well as a trusting relationship between patient and healthcare professionals led to improved outcomes.
INTRODUCTION/BACKGROUND
The rise in hospice/palliative home care services requires incorporation of interdisciplinary-based approaches to healthcare.
Home based palliative care is a critical segment of the health care system.
An interdisciplinary collaborative management approach, which focuses on care coordination amongst multiple providers, patients and families, to this patient population, is fundamental in delivering the highest quality of care.
Two major outcome measures that may be improved by the interdisciplinary collaboration model are patient satisfaction and acute care visits.
Table 1: Patient satisfaction in IHPC plus usual care vs usual care
Outcomes
Follow- ups
Intervention group (IHPC)
(n=145)
Usual care (n=152)
P value
Patient satisfaction
(%) 30 60 90
93.1%
92.3%
93.4%
80%
87%
80.8%
0.006
0.26
0.03
Emergency department visits
Hospital visits
20%
36%
33%
59%
0.01
0.001
IMPLICATIONS FOR PRACTICE
PURPOSE/OBJECTIVE
Education of patients and families in the use of medications, self-management skills, and crisis intervention may be crucial in stabilizing the patient and minimizing excessive emergency department visits and hospital admissions.
Continuing education of health professionals may be necessary to promote active learning and collaboration within care teams and can optimize the likelihood of achieving outcomes such as reductions in re-admissions and improved patient satisfaction.
Both clinical and financial outcomes may improve with an interdisciplinary team based approach.
Early intervention may also help decrease the number of patients returning to the hospital.
The purpose of this project is to improve interdisciplinary collaboration among the hospice/palliative team. The objective of this project is to:
Provide a trusting relationship between patient and healthcare professionals.
Evaluate the effectiveness of structured interdisciplinary collaboration on patient satisfaction and re-admission rates for adults receiving home hospice/palliative care services.
Maintain interdisciplinary collaboration among care teams to impact patient satisfaction and reduce re-admission rates.
Enable coordination of care to the provision of services that enable continuity of care.
Data from: Brumley et al., 2007
Table 2: ED visits and hospital admissions in IHPC plus usual care vs usual care
Outcomes
Follow- ups
Intervention group
Palliative Care (n=161)
Usual care
(n=139)
P value
Patient satisfaction
60 days
-2.57
-0.5
0.01
Emergency department visits
Hospital visits
0.930 (2.51)
2.359 (10.96)
2.297(0.92)
9.352 (10.82)
<0.001
CONCLUSIONS
MATERIALS AND METHODS
The findings of this review suggest that structured interdisciplinary team collaboration in home palliative care teams has led to improvement in the patient satisfaction and hospital admission rates. 
The evidence suggests that in patients receiving palliative home care, interdisciplinary collaboration amongst care team members contributes to higher patient satisfaction and reduced emergency visits and hospitalization rates.
Although none of the studies included looked at home hospice, health care professionals who specialize in hospice and palliative care work collaboratively with patients and families to address symptoms with the aim of promoting comfort at the end of life.
The available evidence supporting only the interdisciplinary collaboration on home palliative care patients is only modest and not without methodological flaws.
Method
The search strategy aimed to find unpublished literature in the English language was sought from the inception of the databases through August 15th, 2014.The databases searched included: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Nursing & Allied Health Source, Health Source: Nursing/Academic Edition and Pro Quest Health Management. A search of the grey literature and any relevant homecare/hospice/palliative websites was also performed.
Key words: Structured Interdisciplinary collaboration, interprofessional collaboration, patient satisfaction, hospital admissions, hospital readmissions, adult, home-hospice services, palliative care, palliative care nursing, hospice home care services, acute care visits, emergency department visits.
Inclusion criteria: This review considered randomized controlled trials. In the absence of randomized controlled trials, other research designs, such as non- randomized control trials, quasi-experimental studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies, and before and after studies were considered for inclusion. The outcome was defined as patient satisfaction and all cause hospital admissions and re-admission rates, emergency department visits, and acute care visits. This review considered studies that include adults, male and female (18 years or older) receiving palliative home care services.
Data collection and analysis: Two independent reviewers evaluated the studies for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data were extracted and analyzed using the JBI- MAStARI program.
Data from: Brumley et al., 2007
REFERENCES
Boon T. (2002). Examining hospice team meetings. Caring: National Association For Home Care Magazine, 21(10):24–26.
Costantini, G. D., McDermott, M., Primiano, D., Santomassino, M., Slyer, J. T., & Singleton, J. K. (2011). A Systematic Review of Continuity of care and its role in patient satisfaction and decreased hospital admissions in the adult patient receiving home care services. The JBI Database of Systematic Reviews and Implementation Reports, 9(64 Suppl), S251-S260.
Rhodes, R. L., Mitchell, S. L., Miller, S. C., Connor, S. R., & Teno, J. M. (2008). Bereaved family members' evaluation of hospice care: what factors influence overall satisfaction with services?. Journal of pain and symptom management, 35(4),
Contact information
ACKNOWLEDGEMENTS
Durline Brown-Manhertz FNP
Pace University, New York, NY
Cell
URL-
This work was supported by Pace University mentors and staff. Thanks to the following Dr. Jason Slyer, Jennifer Rosenstein and Bonnie Lauder for their invaluable assistance and guidance with this systematic review project.
There was no conflict of interest.
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