Effects of a program for coordinated care of advanced illness on patients, surrogates, and healthcare costs: a randomized trial.
Effects of a program for coordinated care of advanced illness on patients, surrogates, and healthcare costs: a randomized trial.
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晚期疾病协调护理计划对患者、代理人和医疗费用的影响：一项随机试验。
DOI：
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发表时间：
2006
影响因子：
3.2
通讯作者：
D. Tobin
中科院分区：
文献类型：
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作者：
Joseph B. Engelhardt;Kimberly P. McClive;R. Toseland;Tamara L. Smith;D. Larson;D. Tobin
OBJECTIVE
To evaluate the Advanced Illness Coordinated Care Program (AICCP), delivered by allied health personnel to improve care for patients coping with advanced illness and in need of preparation for end-of-life (EOL) care.
STUDY DESIGN
Clinical trial involving 275 patients and 143 surrogates in 6 settings who were randomly assigned to the AICCP or usual care (UC).
METHODS
The AICCP participants met with a care coordinator for assistance with provider communication, care coordination, and support. The AICCP was evaluated for effects on satisfaction with care, advance planning, consistency of care with patient preferences, and healthcare costs.
RESULTS
The AICCP increased patient satisfaction with care and communication (P = .03), and AICCP surrogates reported fewer problems with provider support (P = .03). More AICCP than UC participants completed an advance directive (AD) (69.4% vs 48.4%; P = .006), and the AICCP group completed more ADs per participant (P = .01). Median time to AD documentation was 46 days for AICCP and 238 days for UC (P = .02). There was no difference in survival (AICCP 43% vs UC 42%). Six-month costs were lower with AICCP than with UC (12,123 US dollars vs 16,295 US dollars); however, the difference did not reach statistical significance.
CONCLUSIONS
The AICCP improved satisfaction with care and helped patients develop and revise more ADs, sooner, without affecting mortality. This program may be delivered in a range of managed care, fee-for-service, and group-model settings.
