Community Based Self Management of COPD Facilitated by a Palliative Care Team:Impact on Health Care Utilization and QOL

Study Overview
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Brief Summary
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The purpose of this study is to compare in home support services for patients with COPD with usual care. The study is designed to evaluate the impact of an interdisciplinary palliative care team on community based self management of advanced COPD. A total of thirty patients will be enrolled into this study. Twenty patients will be randomly assigned to receive usual care, and ten patients will be randomly assigned to usual care plus in home support services. This study will use objective criteria to identify patients with COPD likely to benefit from home based palliative care services. The patients will undergo initial assessment by medical, social work, and spiritual care personnel followed by a family meeting to establish a care plan. Periodic scheduled visits, and as needed unscheduled visits to address urgent needs will occur over one year's time in an attempt to return patients with COPD to the center of decision making regarding their care, avoid acute exacerbations and thereby avoid unscheduled clinic and ER visits. Patients will complete the QOL survey and symptom assessment scale upon initial intervention. After obtaining information from all patients who qualify for the study, participants will be randomized into cohorts. Those who are randomized to serve as cases will be provided with community based self management services by an interdisciplinary palliative care team. The control group will receive standard care. At the conclusion of 12 months both cases and controls will again complete the QOL survey,medical utilization, and symptom assessment.

Official Title
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Community Based Self Management of COPD Facilitated by a Palliative Care Team:Impact on Health Care Utilization and QOL

Conditions
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Pulmonary Disease Chronic Obstructive

Intervention / Treatment
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* Other: Palliative home care in advanced COPD
* Other: Standard of care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 60 or greater Dx of COPD Received 2 or more unscheduled acute care visits during the 12 months from Jan 2007-Dec 2007 SMDC primary care provider Lives within 50 miles of Duluth Minnesota Informed consent Exclusion Criteria: Non English speaking Too ill or cognitively impaired to provide baseline data or informed consent Lives more than 50 miles from Duluth Nursing home resident

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Home-based palliative care services<br>Patients who are 60 or more years of age and have a diagnosis of COPD.Patients who have received two or more unscheduled acute care visits during the 12 months prior to the start of the study. | Other: Palliative home care in advanced COPD<br>* Interdisciplinary palliative care team on community based self care management of advanced COPD.<br>|
| Standard of care<br>Patients who are 60 or more years of age and have a diagnosis of COPD.Patients who have received two or more unscheduled acute care visits during the 12 months prior to the start of the study. | Other: Standard of care<br>* Usual care for COPD patients<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Health service utilization, symptom scores, and patient quality of life | Health care utilization: over 12 months while enrolled on study vs. 12 months prior to enrollment. For symptom scores and quality of life: at the time of enrollment and at the end of 12 months study period. | Baseline and 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Community based self management of COPD with palliative care