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, 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

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 = 903) were estimated to be within 3 years of end of life and diagnosed with 1+ 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 = 173, 38%) than UC patients (N = 66, 15%; P < .001). LifeCourse patients who died spent more days in hospice (88 ± 191 days) compared to UC patients (44 ± 71 days; P = .018). LifeCourse patients reported greater improvements than UC in communication as part of the care experience ( P = .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 .

Keywords: care navigator; community health worker; late life; palliative care; person-centered program; whole-person care.

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Modified CONSORT diagram for the LifeCourse study.
Figure 2.
Figure 2.
Random coefficients regression model showing the relationship between treatment group and the communication domain of care experience over time.

References

    1. Murray SA, Boyd K, Kendall M, Worth A, Benton TF, Clausen H. Dying of lung cancer or cardiac failure: prospective qualitative interview study of patients and their carers in the community. BMJ. 2002;325(7370):929.
    1. Hegarty MM, Abernethy AP, Olver I, Currow DC. Former palliative caregivers who identify that additional spiritual support would have been helpful in a population survey. Palliat Med. 2011;25(3):266–277.
    1. Hanson LC, Armstrong TD, Green MA, et al. Circles of care: development and initial evaluation of a peer support model for African Americans with advanced cancer. Health Edu & Behav. 2013;40(5):536–543.
    1. Hartgerink JM, Cramm JM, Bakker TJ, Mackenbach JP, Nieboer AP. The importance of older patients’ experiences with care delivery for their quality of life after hospitalization. BMC Health Serv. 2015;15:311.
    1. Kastbom L, Milberg A, Karlsson M. A good death from the perspective of palliative cancer patients. Support Care Cancer. 2017;25(3):933–939.
    1. Schneider H, Lehmann U. Lay health workers and HIV programmes: implications for health systems. AIDS Care. 2010;22:60–67.
    1. Kangovi S, Mitra N, Grande D, et al. Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. JAMA Intern Med. 2014;174(4):535–543.
    1. Wittenberg E, Prosser LA. Health as a family affair. N Engl J Med. 2016;374(19):1804–1806.
    1. Arno PS, Levine C, Memmott MM. The economic value of informal caregiving. Health Aff. 1999;18(2):182–188.
    1. Chari AV, Engberg J, Ray KN, Mehrotra A. The opportunity costs of informal elder-care in the United States: new estimates from the American Time Use Survey. Health Serv Res. 2015;50(3):871–882.
    1. National Alliance for Caregiving and AARP Public Policy Institute. Caregiving in the U.S. 2015. . Accessed November 30, 2018.
    1. Farquhar M, Penfold C, Walter FM, Kuhn I, Benson J. What are the key elements of educational interventions for lay carers of patients with advanced disease? A systematic literature search and narrative review of structural components, processes and modes of delivery. J Pain Symptom Manage. 2016;52(1):117–130.e127.
    1. Grande G, Stajduhar K, Aoun S, et al. Supporting lay carers in end of life care: current gaps and future priorities. Palliat Med. 2009;23(4):339–344.
    1. Anderson EW, White KM. “This is what family does”: the family experience of caring for serious illness. Am J Hosp Palliat Care. 2018;35(2):348–354.
    1. Mount B, Kearney M. Healing and palliative care: charting our way forward. Palliat Med. 2003;17(8):657–658.
    1. Kearney M. A Place of Healing: Working with Nature and Soul at the End of Life. New Orleans: Spring Journal; 2009.
    1. Hutchinson TA, Hutchinson N, Arnaert A. Whole person care: encompassing the two faces of medicine. CMAJ. 2009;180(8):845–846.
    1. Cassel C, Katherine F. Principles for Care of Patients at the End of Life: An Emerging Consensus Among the Specialties of Medicine. New York: Millbank Memorial Fund; 1999.
    1. Spetz J, Dudley N, Trupin L, Rogers M, Meier DE, Dumanovsky T. Few hospital palliative care programs meet national staffing recommendations. Health Aff. 2016;35(9):1690–1697.
    1. Overview for policymakers: Growing demand, limited supply. Center to Advance Palliative Care; 2016. . Accessed November 30, 2018.
    1. Adair R, Wholey DR, Christianson J, White KM, Britt H, Lee S. Improving chronic disease care by adding laypersons to the primary care team: a parallel randomized trial. Ann Intern Med. 2013;159(3):176–184.
    1. American Public Health Association. Community Health Workers. 2018. . Accessed November 30, 2018.
    1. Lewin S, Babigumira S, Bosch-Capblanch X, et al. Lay Health Workers in Primary and Community Health Care: A Systematic Review of Trials. Geneva: WHO; 2006.
    1. Thom DH, Ghorob A, Hessler D, De Vore D, Chen E, Bodenheimer TA. Impact of peer health coaching on glycemic control in low-income patients with diabetes: a randomized controlled trial. Ann Fam Med. 2013;11(2):137–144.
    1. Viswanathan M, Kraschnewski J, Nishikawa B, et al. Outcomes of community health worker interventions. Evid Rep Technol Assess (Full Report). June 2009;(181):1–44.
    1. Galbraith AA, Meyers DJ, Ross-Degnan D, et al. Long-term impact of a postdischarge community health worker intervention on health care costs in a safety-net system. Health Serv Res. 2017;52(6):2061–2078.
    1. Herber OR, Johnston BM. The role of healthcare support workers in providing palliative and end-of-life care in the community: a systematic literature review. Health Soc Care Community. 2013;21(3):225–235.
    1. Lanese BS, Dey A, Srivastava P, Figler R. Introducing the health coach at a primary care practice: a pilot study (part 2). Hosp Top. 2011;89(2):37–42.
    1. Lanese BS, Dey A, Srivastava P, Figler R. Introducing the health coach at a primary care practice: impact on quality and cost (Part 1). Hosp Top. 2011;89(1):16–22.
    1. Leahey TM, Wing RR. A randomized controlled pilot study testing three types of health coaches for obesity treatment: professional, peer, and mentor. Obesity. 2013;21(5):928–934.
    1. Litzelman DK, Inui TS, Griffin WJ, et al. Impact of community health workers on elderly patients’ advance care planning and health care utilization: moving the dial. Med Care. 2017;55(4):319–326.
    1. Adair R, Christianson J, Wholey DR, et al. Care guides: employing nonclinical laypersons to help primary care teams manage chronic disease. J Ambul Care Manage. 2012;35(1):27–37.
    1. Adelman AM, Graybill M. Integrating a health coach into primary care: reflections from the Penn State Ambulatory Research Network. Ann Fam Med. 2005;3(suppl 2):S33–S35.
    1. Hendren S, Griggs JJ, Epstein RM, et al. Study protocol: a randomized controlled trial of patient navigation-activation to reduce cancer health disparities. BMC Cancer. 2010;10:551.
    1. Bensink ME, Ramsey SD, Battaglia T, et al. Costs and outcomes evaluation of patient navigation after abnormal cancer screening: evidence from the Patient Navigation Research Program. Cancer. 2014;120(4):570–578.
    1. Rocque GB, Partridge EE, Pisu M, et al. The patient care connect program: transforming health care through lay navigation. J Oncol Pract. 2016;12(6):e633–e642.
    1. Rocque GB, Pisu M, Jackson BE, et al. Resource use and Medicare costs during lay navigation for geriatric patients with cancer. JAMA Oncol. 2017;3(6):817–825.
    1. Kim K, Choi JS, Choi E, et al. Effects of community-based health worker interventions to improve chronic disease management and care among vulnerable populations: a systematic review. Am J Public Health. 2016;106(4):e3–e28.
    1. Kangovi S, Mitra N, Grande D, Huo H, Smith RA, Long JA. Community health worker support for disadvantaged patients with multiple chronic diseases: a randomized clinical trial. Am J Public Health. 2017;107(10):1660–1667.
    1. Calhoun EA, Whitley EM, Esparza A, et al. A national patient navigator training program. Health Promo Practice. 2010;11(2):205–215.
    1. Jack HE, Arabadjis SD, Sun L, Sullivan EE, Phillips RS. Impact of community health workers on use of healthcare services in the United States: a systematic review. J Gen Intern Med. 2017;32(3):325–344.
    1. National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care, 3rd ed Pittsburgh, PA: National consensus project for quality palliative care; 2013.
    1. National Consensus Project for Quality Palliative Care. Clinical practice guidelines for quality palliative care. Kans Nurse. 2004;79(9):16.
    1. Rollnick S, Miller WR, Butler CC, Aloia MS. Motivational interviewing in health care: helping patients change behavior. New York, NY: The Guilford Press; 2008.
    1. Dillman DA. Mail and Internet Surveys; The Tailored Design Method, 2nd ed New York, NY: John Wiley & Sons, Inc; 2000: 167–170.
    1. Webster K, Cella D, Yost K. The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: properties, applications, and interpretation. Health Qual Life Outcomes. 2003;1(1):79.
    1. Fernstrom KM, Shippee ND, Jones AL, Britt HR. Development and validation of a new patient experience tool in patients with serious illness. BMC Palliat Care. 2016;15(1):99.
    1. Cella D, Riley W, Stone A, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol. 2010;63(11):1179–1194.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する