NEW YORK (Reuters Health) - In-home care for terminally ill patients can improve patient satisfaction while reducing medical care costs, researchers report in the Journal of the American Geriatric Society. The team says the findings provide "strong evidence for reforming end-of-life care."

The study "supported our goal of enhancing care to chronically ill patients by providing comprehensive, coordinated, and compassionate care by an interdisciplinary team of health care providers," lead investigator Dr. Richard Brumley told Reuters Health.

Brumley of Kaiser Permanente Hospice and Palliative Care, Downey, California and colleagues note that the "current medical care structure is inadequate in meeting the needs of terminally ill patients and reducing the cost of care at the end of life."

Hospice care, they add, is available through Medicare, but the program is underused and 60 percent of all deaths take place in hospital.

To examine whether in-home palliative care might be a practical alternative, the researchers studied 298 home-bound terminally ill patients. Palliative care consists of treatment that is not intended to cure the patient, but to ease the pain and to make the patient as comfortable as possible.

The study patients had pulmonary disease, congestive heart failure or cancer, and were expected to live no more than a year. All had had at least one hospital or emergency room visit in the previous 12 months.

The patients were randomly assigned to the usual care or to in-home palliative care (along with usual care) delivered by an interdisciplinary team who provided pain and symptom relief, patient and family education, and medical and social support services.

The patients in the palliative care group reported significantly greater satisfaction with care by 30 and 90 days after enrollment and were significantly more likely to die at home than those receiving usual care (71 percent versus 51 percent).

In addition, in-home palliative care patients were significantly less likely to visit the emergency department or be admitted to hospital than those receiving the usual care. This resulted in significantly lower costs. In fact, the average cost per day was $95.30 for palliative care patients, less than half of the $212.80 per day costs incurred by usual care participants.

"By involving patients and families with discussions about their illness and various treatment options, desires and concerns," concluded Brumley, "we were able to successfully redirect the focus of care to the home setting, which patients prefer, while reducing dependency on acute, inpatient care."

SOURCE: Journal of the American Geriatric Society, July 2007.