Quasi-Experimental Evaluation of LifeCourse on Utilization and Patient and Caregiver Quality of Life and Experience
Quasi-Experimental Evaluation of LifeCourse on Utilization and Patient and Caregiver Quality of Life and Experience
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DOI：
10.1177/1049909118817740
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发表时间：
2019-05-01
影响因子：
1.9
通讯作者：
Anderson, Eric W.
中科院分区：
文献类型：
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作者：
Britt, Heather R.;Jaka, Meghan M.;Anderson, Eric W.
全人护理是治疗严重疾病的新范例，但很少有项目经过深入研究。我们采用准实验设计和常规护理 (UC) 对照组，试图测试 LifeCourse (LC)（一项以人为本的计划，针对严重疾病患者）对医疗保健利用、护理体验和生活质量的影响。该研究于 2012 年至 2017 年在中西部北部的一个非营利性医疗保健系统进行，每 3 个月测量一次结果，直至生命结束。纳入的患者 (N = 903) 估计在生命结束后 3 年内被诊断患有 1+ 种严重疾病。排除标准包括筛查时或主动死亡时的临终关怀登记。社区卫生工作者 (CHW) 根据姑息治疗指南和动机访谈提供每月 1 小时的标准化家访，以促进患者的身体、心理和财务健康。主要结局包括医疗保健利用率以及患者和护理人员的体验以及生活质量。患者为老年人（LC 74 岁，UC 78 岁），主要是非西班牙裔白人，居住在家里，主要诊断为心血管疾病（LC 69%，UC 57%）。 LC 患者完成预先指示的比例 (N = 173, 38%) 高于 UC 患者 (N = 66, 15%; P < .001)。与 UC 患者 (44 +/- 71 天；P = .018) 相比，LifeCourse 死亡患者在临终关怀中心度过的天数更长 (88 +/- 191 天)。作为护理体验的一部分，LifeCourse 患者的沟通能力比 UC 患者有更大的改善 (P = .016)。实施由社区卫生工作者提供的以人为本的计划是可行的；姑息治疗模式的廉价上游扩张可以为患者和护理人员带来好处。试验注册：试验 NCT01746446 于 2012 年 11 月 27 日在 注册。
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 .