Outcome evaluation of a randomized trial of the PhoenixCare intervention: Program of case management and coordinated care for the seriously chronically ill
Outcome evaluation of a randomized trial of the PhoenixCare intervention: Program of case management and coordinated care for the seriously chronically ill
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DOI：
10.1089/jpm.2006.9.111
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发表时间：
2006-02-01
影响因子：
2.8
通讯作者：
Williams, Frank G.
中科院分区：
文献类型：
--
作者：
Aiken, Leona S.;Butner, Jonathan;Williams, Frank G.
目的：记录一项针对同时接受管理性护理组织(MCoS)积极治疗的严重慢性病患者的菲尼克斯护理示范计划的随机试验结果。设计：1999年7月至2001年3月期间连续登记的患者被随机分配到菲尼克斯护理计划或接受常规MCO护理的对照组。地点：亚利桑那州凤凰城山谷临终关怀。参与者：192名慢性阻塞性肺疾病(COPD)或慢性心力衰竭(CHF)患者，他们的预期寿命估计为2年。干预：由注册护士病例管理人员与患者现有的医疗护理来源协调提供基于家庭的强化病例管理。项目重点包括疾病和症状管理、患者对疾病的自我管理和疾病相关资源的了解、临终准备、身心功能和医疗服务利用。结果：结果：每3个月通过电话访谈评估一次结果，包括与所有项目重点相关的测量；SF-36(TM)用于评估身心功能；急诊科就诊是医疗服务利用的例证。结果：与对照组相比，Phoenixcare患者在疾病自我管理、对疾病相关资源的认识和为临终前的法律准备方面的结果显著好于对照组。他们报告说，与随机对照组相比，他们的症状痛苦程度更低，活力更强，身体功能更好，自我评估的健康程度更高。急诊科的使用率在不同组之间是相同的。COPD患者对干预表现出更强的反应性。结论：一种新的患者护理模式，将以姑息治疗为重点的病例管理与持续的以MCO为基础的治疗相结合，与慢性重症患者在生命最后几年的功能改善有关。
Objective: To document outcomes of a randomized trial of the PhoenixCare demonstration program of palliative care and coordinated care/case management for seriously chronically ill individuals who simultaneously received active treatment from managed care organizations (MCOS).Design: Patients, continuously enrolled between July 1999, and March 2001, were randomly assigned to the PhoenixCare program or a control group receiving usual MCO care.Setting: Hospice of the Valley, Phoenix, Arizona. Participants:Participants were 192 patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF), who had an estimated 2-year life expectancy.Intervention: Intensive home-based case management provided by registered nurse case-managers, in coordination with patients' existing source of medical care, comprised the intervention. Program foci included disease and symptom management, patient self-management of illness and knowledge of illness-related resources, preparation for end-of life, physical and mental functioning, and utilization of medical services.Outcome measures: Outcomes, assessed every 3 months by telephone interview, included measures related to all program foci; the SF-36(TM) was used to evaluate physical and mental functioning; emergency department visits exemplified medical service utilization.Results: Compared to controls, PhoenixCare patients exhibited significantly better outcomes on self-management of illness, awareness of illness-related resources, and legal preparation for end of life. They reported lower symptom distress, greater vitality, better physical functioning and higher self-rated health than randomized controls. Emergency department utilization was equivalent across groups. Patients with COPD showed stronger responsiveness to the intervention.Conclusion: A novel model of patient care that combined greatly enhanced palliative care-focused case management with ongoing MCO-based treatment was associated with improved functioning of chronically severely ill patients in the last years of life.