Effects of a program for coordinated care of advanced illness on patients, surrogates, and healthcare costs: a randomized trial.
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.


METHODS
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.
Engelhardt
Joseph B
JB
Center for Advanced Illness Coordinated Care, Veterans Affairs Health Care Network/Upstate New York, 113 Holland Ave (11T), Albany, NY 12208, USA.
McClive-Reed
Kimberly P
KP
Toseland
Ronald W
RW
Smith
Tamara L
TL
Larson
Dale G
DG
Tobin
Daniel R
DR
D000328:Adult; D032722:Advance Care Planning / Q000458:organization & administration*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D020458:Third-Party Consent; D014481:United States