Publication Date

Spring 2016

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Constance Hill

Second Advisor

Donna Zulman

Third Advisor

Jonathan Shaw


Case management, Hospice, End-of-life


Objective: The purpose of this study is to examine if patients enrolled in multi-disciplinary intensive case management program (ImPACT) alter the patient’s end-of-life path or setting of death.

Methods: The quality improvement project is a quantitative retrospective study that compared patients receiving standard primary care vs intensive case management (ImPACT) during 2/2013-1/2014. It is a secondary analysis of a larger study of a quality improvement evaluation that took place at the Veterans Administration facility in Palo Alto, Ca.

Results: Among the 82 patients who died, 19 were enrolled in ImPACT for approximately 249 days compared to 63 who received standard care. The patients had more than 10 chronic conditions with the average age of 71 years. There was a statistically significant relationship between the ImPACT patients and hospice utilization. 74 % of the ImPACT patients enrolled in hospice care vs 45% of the standard care group. There was no significant relationship between the days on hospice between both groups. However, the majority of the ImPACT patients died on inpatient VA hospice (50%) or home (26%) compared to standard care in which 27% died on inpatient VA hospice and 34% died at home.

Conclusions: This study was the first to examine if intensive case management (ImPACT) would alter the patient’s end-of-life path or setting of death. ImPACT was successful in promoting hospice referral compared to patients receiving standard care.


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