title: Effectiveness of care coordination and health counseling in advancing illness.
abstract: OBJECTIVE
  To evaluate the Advanced Illness Coordinated Care Program (hereafter AICCP) for effects on health delivery among patients and caregivers, quality of life, advance planning, and health service utilization.
  
  
  METHODS
  Prospective trial involving 532 patients and 185 caregivers. AICCP consisted of care coordination, health counseling, and education delivered in cooperation with physicians.
  
  
  METHODS
  Patients with advanced disease and their caregivers were assigned to AICCP or usual care (UC). Data sources included self-report, medical record review, and health plan databases. Statistical analyses used t test, chi(2) test, regression analysis, and analysis of variance.
  
  
  RESULTS
  Compared with those in UC, AICCP participants had improved communication and care concerning symptoms (P = .02), support in understanding and coping with their illness (P = .01), advance planning (P <.001), support in managing family decision making (P = .002), and help in accessing spiritual support (P <.001). AICCP caregivers received more attention for emotional and spiritual needs (P = .02). AICCP participants were 2.23 times more likely to formulate an advance directive (P <.001) (5.5 months sooner [P <.001]) and were 1.26 times more likely to agree to a do-not-resuscitate or do-not-intubate order (P = .04). AICCP participants had on average 1.89 fewer inpatient admissions (P = .045). There was no difference in 1-year survival (P = .80).
  
  
  CONCLUSIONS
  AICCP improved communication and care delivery, advance planning, and do-not-resuscitate or do-not-intubate orders in a population at risk to use them. AICCP had fewer admissions. Coordination and health counseling seem matched for those coping with advancing illness.
authors.affiliation: Care Support of America, Albany, NY 12208, USA. jengelhardt@caresupportofamerica.com
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Engelhardt
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Rizzo
authors.forename: Richard D
authors.initials: RD
authors.lastname: Della Penna
authors.forename: Paul A
authors.initials: PA
authors.lastname: Feigenbaum
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Kirkland
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Nicholson
authors.forename: Maureen C
authors.initials: MC
authors.lastname: O'Keeffe-Rosetti
authors.forename: Ingrid M
authors.initials: IM
authors.lastname: Venohr
authors.forename: Pamela Gray
authors.initials: PG
authors.lastname: Reger
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Tobin
mesh_terms: D016223:Advance Directives; D000368:Aged; D017028:Caregivers; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D015397:Program Evaluation; D011446:Prospective Studies; D011788:Quality of Life; D016414:Resuscitation Orders; D012944:Social Support; D019452:Terminally Ill