Outcome evaluation of a randomized trial of the PhoenixCare intervention: program of case management and coordinated care for the seriously chronically ill.
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).


METHODS
Patients, continuously enrolled between July 1999, and March 2001, were randomly assigned to the PhoenixCare program or a control group receiving usual MCO care.


METHODS
Hospice of the Valley, Phoenix, Arizona.


METHODS
Participants were 192 patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF), who had an estimated 2-year life expectancy.


METHODS
Intensive home-based case management provided by registered nurse casemanagers, 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.


METHODS
Outcomes, assessed every 3 months by telephone interview, included measures related to all program foci; the SF-36 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.


CONCLUSIONS
A novel model of patient care that combined greatly enhanced palliative carefocused case management with ongoing MCO-based treatment was associated with improved functioning of chronically severely ill patients in the last years of life.
Aiken
Leona S
LS
Department of Psychology, Arizona State University, Tempe, Arizona 85287-1104, and Hospice of the Valley, Phoenix, AZ, USA. Leona.Aiken@asu.edu
Butner
Jonathan
J
Lockhart
Carol A
CA
Volk-Craft
Barbara E
BE
Hamilton
Gillian
G
Williams
Frank G
FG
D000328:Adult; D000704:Analysis of Variance; D001130:Arizona; D019090:Case Management / Q000458:organization & administration*; D006738:Hospices / Q000458:organization & administration*; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000458:organization & administration*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*