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Am J Manag Care. 2009 Nov;15(11):817-25.

Effectiveness of care coordination and health counseling in advancing illness.

Author information

  • 1Care Support of America, Albany, NY 12208, USA. jengelhardt@caresupportofamerica.com

Abstract

OBJECTIVE:

To evaluate the Advanced Illness Coordinated Care Program (hereafter AICCP) for effects on health delivery among patients and caregivers, quality of life, advance planning, and health service utilization.

STUDY DESIGN:

Prospective trial involving 532 patients and 185 caregivers. AICCP consisted of care coordination, health counseling, and education delivered in cooperation with physicians.

METHODS:

Patients with advanced disease and their caregivers were assigned to AICCP or usual care (UC). Data sources included self-report, medical record review, and health plan databases. Statistical analyses used t test, chi(2) test, regression analysis, and analysis of variance.

RESULTS:

Compared with those in UC, AICCP participants had improved communication and care concerning symptoms (P = .02), support in understanding and coping with their illness (P = .01), advance planning (P <.001), support in managing family decision making (P = .002), and help in accessing spiritual support (P <.001). AICCP caregivers received more attention for emotional and spiritual needs (P = .02). AICCP participants were 2.23 times more likely to formulate an advance directive (P <.001) (5.5 months sooner [P <.001]) and were 1.26 times more likely to agree to a do-not-resuscitate or do-not-intubate order (P = .04). AICCP participants had on average 1.89 fewer inpatient admissions (P = .045). There was no difference in 1-year survival (P = .80).

CONCLUSIONS:

AICCP improved communication and care delivery, advance planning, and do-not-resuscitate or do-not-intubate orders in a population at risk to use them. AICCP had fewer admissions. Coordination and health counseling seem matched for those coping with advancing illness.

PMID:
19895186
[PubMed - indexed for MEDLINE]
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