Quasi-Experimental Evaluation of LifeCourse on Utilization and Patient and Caregiver Quality of Life and Experience

Heather R. Britt, Meghan M. JaKa, Karl M. Fernstrom, Paige E. Bingham, Anne E. Betzner, Jessica R. Taghon, Nathan D Shippee, Tetyana P Shippee, Sandra E. Schellinger, Eric W. Anderson

Research output: Contribution to journalArticlepeer-review

Abstract

Whole-person care is a new paradigm for serious illness, but few programs have been robustly studied. We sought to test the effect of LifeCourse (LC), a person-centered program for patients living with serious illness, on health-care utilization, care experience, and quality of life, employing a quasi-experimental design with a Usual Care (UC) comparison group. The study was conducted 2012 to 2017 at an upper-Midwest not-for-profit health-care system with outcomes measured every 3 months until the end of life. Enrolled patients (N ¼ 903) were estimated to be within 3 years of end of life and diagnosed with 1þ serious illness. Exclusion criteria included hospice enrollment at time of screening or active dying. Community health workers (CHWs) delivered standardized monthly 1-hour home visits based on palliative care guidelines and motivational interviewing to promote patients' physical, psychosocial, and financial well-being. Primary outcomes included health-care utilization and patient-and caregiver-experience and quality of life. Patients were elderly (LC 74, UC 78 years) and primarily non-Hispanic, white, living at home with cardiovascular disease as the primary diagnosis (LC 69%, UC 57%). A higher proportion of LC patients completed advance directives (N ¼ 173, 38%) than UC patients (N ¼ 66, 15%; P <.001). LifeCourse patients who died spent more days in hospice (88 + 191 days) compared to UC patients (44 + 71 days; P ¼ .018). LifeCourse patients reported greater improvements than UC in communication as part of the care experience (P ¼ .016). Implementation of person-centered programs delivered by CHWs is feasible; inexpensive upstream expansion of palliative care models can yield benefits for patients and caregivers. Trial Registration: Trial NCT01746446 was registered on November 27, 2012 at ClinicalTrials.gov.
Original languageEnglish (US)
JournalAmerican Journal of Hospice and Palliative Medicine
DOIs
StatePublished - Dec 13 2018

Keywords

  • care navigator
  • community health worker
  • late life
  • palliative care
  • person-centered program
  • whole-person care

PubMed: MeSH publication types

  • Journal Article
  • Clinical Study

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