A Tale of Two Trials: A Comparative Case Study of Successful versus Terminated Home-Based Palliative Care Trials.

In 2007 we published a trial of home-based palliative care (HBPC) conducted in a managed care organization (MCO) that found significant improvements in patient satisfaction with health care, rates of home deaths, and reductions in health care use and costs. A decade later, we undertook a similar trial of HBPC within accountable care organizations (ACOs) funded by the Patient-Centered Outcomes Research Institute. This trial tested the same model using similar eligibility criteria and recruitment strategies as the earlier trial, yet it failed to achieve its enrollment targets.

"You cannot stop talking about palliative care:" Perspectives and Learnings from Providers on Communicating about Home-based Palliative Care to Patients and Physicians.

Background: Home-based palliative care (HBPC) programs are proliferating across the U.S, yet face significant, documented challenges in promoting uptake of services and sustaining sufficient patient referrals. There is a huge need to understand effective methods for engaging physicians, patients, and caregivers in palliative care.

Home-Based Palliative Care Organizations Struggle to Survive and Thrive in a Competitive Market.

Background: New opportunities to expand home-based palliative care (HBPC) highlight the need for novel data that explores how HBPC providers currently navigate this nascent business.

Objectives: To investigate how HBPC providers and their organizations sustain their operations in a rapidly evolving market.

Study Design: This was an exploratory, qualitative study.

Improving Palliative Care Knowledge among Hospitalized Hispanic Patients: A Pilot Study.

Lack of knowledge of palliative care has been identified as a primary barrier to access to care, with a recent survey reporting that Hispanics have the lowest rate of palliative care knowledge compared with other racial/ethnic groups. The purpose of this pilot study was to determine if there were trends toward improved palliative care knowledge after viewing four-minute video of a palliative care patient. We conducted a pre- and posttest pilot study among 50 Spanish-speaking, hospitalized Hispanic patients 40 years old and older in a large public hospital.

Home-Based Palliative Care Team Perspectives on Challenges in Patient Referral and Enrollment.

Context: As funding for home-based palliative care continues to expand, there is an increasing need to understand barriers to patient referral to and acceptance of home-based palliative care.

Objectives: The aim of this study was to elicit perspectives of home-based palliative care administrators and providers on barriers encountered in identification, referral, and enrollment of patients eligible for home-based palliative care.

Methods: We conducted a qualitative study employing focus groups of nine home-based palliative care agencies across California.

Health Care Provider Barriers to Patient Referral to Palliative Care.

Objective: The purpose of this study was to explore healthcare provider-perceived challenges to HBPC patient referral and elicited providers' feedback for overcoming these challenges.

Methods: We conducted a qualitative study using semi-structured interview with 25 Medicaid managed care providers (primary care physicians, nurse practitioners, and care managers) working in the greater Los Angeles area. Our interview protocol elicited providers' knowledge and awareness of palliative care; perceived barriers to HBPC referral; and suggestions for overcoming these barriers.