The After Discharge Care Management of Low Income Frail Elderly (AD-LIFE) Randomized Trial: Theoretical Framework and Study Design.
Aged; Frail Elderly; Study Design; Conceptual Framework; Health Care Delivery; Transitional Programs; Models; Theoretical; Treatment Outcomes; Multidisciplinary Care Team; Medical Practice; Poverty; 80 and Over; Evidence-Based; Chronic Disease – Therapy; After Care – Methods; Disease Management – Methods; Integrated – Methods; Randomized Controlled Trials – Evaluation
Interdisciplinary care management is advocated for optimal care of patients with many types of chronic illnesses; however, few models exist that have been tested using randomized trials. The purpose of this report is to describe the theoretical basis for the After Discharge Management of Low Income Frail Elderly (AD-LIFE) trial, which is an ongoing 2-group randomized trial (total n = 530) to test a chronic illness management and transitional care intervention. The intervention is based on Wagner's chronic illness care model and involves comprehensive posthospitalization nurse-led interdisciplinary care management for low income frail elders with chronic illnesses, employs evidence-based protocols that were developed using the Assessing Care of Vulnerable Elders (ACOVE) guidelines, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. The primary aim of the AD-LIFE trial is to test a chronic illness management intervention in vulnerable patients who are eligible for Medicare and Medicaid. This model, with its standardized, evidence-based medical and psychosocial intervention protocols, will be easily transportable to other sites interested in optimizing outcomes for chronically ill older adults. If the results of the AD-LIFE trial demonstrate the superiority of the intervention, then this data will be important for health care policy makers. ( Population Health Management 2011;14:137-142)
Allen Kyle R; Hazelett Susan E; Jarjoura David; Wright Kathy; Fosnight Susan M; Kropp Denise J; Hua Keding; Pfister Eugene W
Population Health Management
2011
2011-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/pop.2010.0016" target="_blank" rel="noreferrer noopener">10.1089/pop.2010.0016</a>
The Promoting Effective Advance Care for Elders (PEACE) Randomized Pilot Study: Theoretical Framework and Study Design.
Ohio; Aged; Quality of Life; Health Care Costs; Pilot Studies; Practice Guidelines; Study Design; Conceptual Framework; Collaboration; Palliative Care; Depression; Goal-Setting; Disease Management; Multidisciplinary Care Team; Anxiety; Home Health Care; Chronic Disease – In Old Age – Ohio; Health Promotion – In Old Age – Ohio
Practice guidelines are available for hospice and palliative medicine specialists and geriatricians. However, these guidelines do not adequately address the needs of patients who straddle the 2 specialties: homebound chronically ill patients. The purpose of this article is to describe the theoretical basis for the Promoting Effective Advance Care for Elders (PEACE) randomized pilot study. PEACE is an ongoing 2-group randomized pilot study ( n = 80) to test an in-home interdisciplinary care management intervention that combines palliative care approaches to symptom management, psychosocial and emotional support, and advance care planning with geriatric medicine approaches to optimizing function and addressing polypharmacy. The population comprises new enrollees into PASSPORT, Ohio's community-based, long-term care Medicaid waiver program. All PASSPORT enrollees have geriatric/palliative care crossover needs because they are nursing home eligible. The intervention is based on Wagner's Chronic Care Model and includes comprehensive interdisciplinary care management for these low-income frail elders with chronic illnesses, uses evidence-based protocols, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. Our model, with its standardized, evidence-based medical and psychosocial intervention protocols, will transport easily to other sites that are interested in optimizing outcomes for community-based, chronically ill older adults. ( Population Health Management 2012;15:71-77)
Allen Kyle R; Hazelett Susan E; Radwany Steven; Ertle Denise; Fosnight Susan M; Moore Pamela S
Population Health Management
2012
2012-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/pop.2011.0004" target="_blank" rel="noreferrer noopener">10.1089/pop.2011.0004</a>
Disentangling consumer and provider predictors of advance care planning.
*Advance Care Planning; *Long-Term Care; Adult; advance care planning; Advance Care Planning; Age Factors; area agencies on aging; Attitude of Health Personnel; care management; Caregivers; community-based care; Conceptual Framework; Consumers; Data Analysis Software; Discussion; Factorial Design; factorial surveys; Female; Human; Humans; Judgment; Long Term Care; long-term care; Middle Age; Multivariate Analysis; Quasi-Experimental Studies; Questionnaires; Random Sample; Registered Nurses; Social Workers; Surveys; Surveys and Questionnaires; Vignettes
Factorial surveys were used to examine community-based long-term care providers' judgments about consumers' need for advance care planning (ACP) and comfort levels in discussing ACP. Providers (448 registered nurses and social workers) judged vignettes based on hypothetical consumers. Hierarchical linear models indicated providers judged consumers who were older, had end-stage diagnoses, multiple emergency department visits, and uninvolved caregivers as most in need of ACP. These variables explained 10% of the variance in judgments. Providers' beliefs about ACP predicted judgments of need for ACP and comfort level in discussing ACP. Provider characteristics explained more variance in comfort levels (44%) than in judgments of need (20%). This study demonstrates the need for tailored educational programs to increase comfort levels and address ACP misconceptions.
Baughman Kristin R; Ludwick Ruth; Merolla David; Palmisano Barbara; Hazelett Susan; Allen Kyle R; Sanders Margaret
The American journal of hospice & palliative care
2013
2013-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1049909112464692" target="_blank" rel="noreferrer noopener">10.1177/1049909112464692</a>