Results of the promoting effective advance care planning for elders (PEACE) randomized pilot study.

Results of the promoting effective advance care planning for elders (PEACE) randomized pilot study.

Radwany Steven M; Hazelett Susan E; Allen Kyle R; Kropp Denise J; Ertle Denise; Albanese Teresa H; Fosnight Susan M; Moore Pamela S

Population Health Management

2014

2014-04

The specific aim of the PEACE pilot study was to determine the feasibility of a fully powered study to test the effectiveness of an in-home geriatrics/palliative care interdisciplinary care management intervention for improving measures of utilization, quality of care, and quality of life in enrollees of Ohio's community-based long-term care Medicaid waiver program, PASSPORT. This was a randomized pilot study (n=40 intervention [IG], n=40 usual care) involving new enrollees into PASSPORT who were \textgreater60 years old. This was an in-home interdisciplinary chronic illness care management intervention by PASSPORT care managers collaborating with a hospital-based geriatrics/palliative care specialist team and the consumer's primary care physician. This pilot was not powered to test hypotheses; instead, it was hypothesis generating. Primary outcomes measured symptom control, mood, decision making, spirituality, and quality of life. Little difference was seen in primary outcomes; however, utilization favored the IG. At 12 months, the IG had fewer hospital visits (50% vs. 55%, P=0.65) and fewer nursing facility admissions (22.5% vs. 32.5%, P=0.32). Using hospital-based specialists interfacing with a community agency to provide a team-based approach to care of consumers with chronic illnesses was found to be feasible. Lack of change in symptom control or quality of life outcome measures may be related to the tools used, as these were validated in populations closer to the end of life. Data from this pilot study will be used to calculate the sample size needed for a fully powered trial.

*Quality of Life; 80 and over; Activities of Daily Living; Advance Care Planning; Advance Care Planning/*organization & administration; Aged; Case Management – Methods; Chi Square Test; Community-Institutional Relations; Comparative Studies; Decision Making; Descriptive Statistics; Disease Management; Family; Female; Frail Elderly; Geriatric Assessment/methods; Health Promotion; Health Resource Utilization; Health Services for the Aged/organization & administration; Home Care Services/*organization & administration; Human; Humans; Interdisciplinary Communication; Long Term Care; Long-Term Care/*organization & administration; Male; Medicaid – Ohio; Multidisciplinary Care Team; Ohio; Outcomes (Health Care); Palliative Care; Palliative Care/organization & administration; Patient; Physicians; Pilot Projects; Pilot Studies – Ohio; Program Evaluation; Psychological Tests; Quality of Life; Random Assignment; Reference Values; Repeated Measures; Scales; Spiritual Care; T-Tests; Treatment Outcome

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