Speakers
David B. Bekelman, MD, MPH
Professor of Medicine and Psychiatry
Rocky Mountain Regional VAMC and University of Colorado Division of General Internal Medicine
Lyndsay DeGroot PhD, RN, CNE
Postdoctoral Fellow
University of Colorado
Anschutz Medical
Campus School of Medicine
Keywords
COPD; Heart Failure; Collaborative Care; Palliative Care
Key Points
- Heart failure (HF) and Chronic Obstructive Pulmonary Disease (COPD) are common illnesses that share a number of symptoms, including persistent breathlessness and fatigue; depression; and anxiety.
- Though HF and COPD patients could benefit from palliative care prior to the end of life, there aren’t enough palliative care specialists to provide care to the patient population.
- ADAPT is a virtual intervention built on a collaborative care team approach. A nurse and social worker provide direct patient care and meet weekly with a collaborative care team – consisting of a primary care physician, palliative care specialist, and as-needed cardiologist and pulmonologist – to review individual cases.
- The research team’s primary aim was to determine the effect of ADAPT on participant quality of life, measured using the FACT-G scale.
- They concluded that a nurse and social worker palliative telecare team demonstrated early, persistent, clinically meaningful improvements in quality of life for high-risk outpatients with COPD, HF, and Interstitial Lung Disease.
- The ADAPT virtual care model leveraged a team of nurses, social workers, and physicians across two large VA health systems to increase the reach of palliative care to common, serious non-cancer illnesses.
- The intervention was relatively inexpensive, but implementing a multifaceted, personnel-intensive program posed its own challenges.
- Future directions include investigating the intervention effect on utilization outcomes and end-of-life outcomes; adapting the model for patients with advanced liver or renal disease; testing other implementation and dissemination strategies; and investigating how to improve adoption.
Discussion Themes
The mortality rate in the population they enrolled was lower than expected. This may be because it is more difficult to enroll very sick patients from an outpatient population.
This study was designed to test the effect of the intervention on quality of life, an outcome that has a significant impact on patients. However, securing funding for work like this can be a challenge, as the program is not designed to reduce costs (unlike interventions that aim to reduce hospitalizations).
There is a need for creative solutions when it comes to funding this model; the research team is looking to collaboration with community partners and examples set by other, similar projects.