The Palliative Care Program

either in acute care units or in intensive care units, sometimes after receiving medically futile care. In 1996, in the Kaiser Permanente (KP) Southern California TriCentral Service Area (KP TriCentral), 63% of patients who died in the intensive care unit and 54% of those who died in the medical/surgical unit had a primary or secondary diagnosis of one of three commonly fatal, incurable conditions: cancer, congestive heart failure (CHF), or chronic obstructive pulmonary disease (COPD). The KP TriCentral leadership subsequently recognized the need to design a program that changed the focus from inpatient to home-based care for patients nearing the end of life. In contrast to traditional models of care—which emphasize curative treatment until death and offer little, if any, palliative care—the program would integrate palliative care into curative care earlier in the patient’s disease process. Seriously ill patients needed services to enable them to better manage their own care at home and thus reduce their need for inpatient and emergency services. With this improved model of end-of-life care, we hypothesized that palliative care patients would be more satisfied with their health care and would use fewer medical services than would their counterparts receiving traditional end-of-life medical care.