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
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DOI：
10.1089/pop.2013.0017
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发表时间：
2014-04-01
影响因子：
2.5
通讯作者：
Moore, Pamela S.
中科院分区：
文献类型：
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作者：
Radwany, Steven M.;Hazelett, Susan E.;Moore, Pamela S.
和平试点研究的具体目的是确定一项全能研究的可行性，以测试家庭老年病/姑息治疗跨学科护理管理干预措施的有效性，以改善俄亥俄州社区长期护理医疗补助豁免计划(Passport)参与者的利用率、护理质量和生活质量。这是一项随机的先导性研究(n=40个干预[IG]，n=40个常规护理)，涉及60岁的护照新注册者。这是由护照护理经理与以医院为基础的老年病/姑息治疗专家团队和消费者的初级保健医生合作的家庭跨学科慢性病护理管理干预。这位飞行员没有能力检验假说；相反，它是在产生假说。主要结果衡量症状控制、情绪、决策、灵性和生活质量。在主要结果中几乎看不到差异；然而，利用有利于IG。12个月时，观察组就诊次数减少(50%比55%，P=0.65)，护理机构入院次数减少(22.5%比32.5%，P=0.32)。使用以医院为基础的专家与社区机构进行交互，以提供基于团队的方法来护理患有慢性病的消费者被发现是可行的。在症状控制或生活质量结果测量方面缺乏变化可能与所使用的工具有关，因为这些工具在接近生命末期的人群中得到了验证。这项先导研究的数据将被用来计算全功率试验所需的样本量。
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 > 60 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.