H3IT: Home Healthcare, Hospice, and Information Technology Conference Washington – D.C., 2014

Sharing the journey: Technology-Enhanced

Transitional Palliative Care

Diane E. Holland

, Catherine E. Vanderboom

, Cory J.Ingram

, Ann Marie Dose

, Ellen Wild

, Kathryn H. Bowles

he majority of palliative care services are located in urban medical centers with few deliberate or consistent

approaches to coordinate care across geographically-diverse settings. This pilot study linked two proven strate-

gies, transitional care and use of health information technology, in an innovative way to extend palliative care

across settings and improve outcomes for rural patients and their caregivers. The purpose of this pilot study

was to determine feasibility, acceptability, and initial outcomes of a technology-enhanced transitional palliative care (TPC)

intervention with

Methods: In this randomized controlled trial, patients/caregivers receiving inpatient palliative care consultation in a rural

Minnesota hospital received either TPC or usual care for 8 weeks after hospital discharge. TPC consisted of one home

visit, periodic phone calls, and weekly video session visits with a nurse via iPad. Attention control patients received weekly

telephone calls by a study team member. All participants were oﬀered a subsequent qualitative telephone interview to assess

feasibility and acceptability. Transcripts were analyzed using content analysis.

Results: Five patients and 7 caregivers were interviewed. Technology use was feasible and acceptable after minor initial

glitches were resolved; all valued viewing their nurse during video sessions. Care coordination was a dominant theme. In-

tervention patients/caregivers experienced satisfactory care coordination, enjoyed continuity provided across settings, and

valued anticipatory guidance received. Care coordination and relationship was absent for the control group; all needed to

manage care and healthcare interactions alone.

Conclusion: TPC is not only feasible, but desired by rural palliative care patients/families transitioning from hospital to

home or other care settings. Video technology was a welcomed adjunct to fostering and maintaining the provider/patient

relationship

Implications for research, policy, or practice: Palliative care should continue beyond the hospital doors; ongoing

follow-up is needed for often worsening healthcare issues for these patients. Policy needs to change to provide reimbursement

for innovative palliative care strategies that span care settings

Mayo Clinic Rochester

Mankato

University of Pennsylvania School of Nursing