title: Primary Results of the Patient-Centered Disease Management (PCDM) for Heart Failure Study: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Heart failure (HF) has a major effect on patients' health status, including their symptom burden, functional status, and health-related quality of life.
  
  
  OBJECTIVE
  To determine the effectiveness of a collaborative care patient-centered disease management (PCDM) intervention to improve the health status of patients with HF.
  
  
  METHODS
  The Patient-Centered Disease Management (PCDM) trial was a multisite randomized clinical trial comparing a collaborative care PCDM intervention with usual care in patients with HF. A population-based sample of 392 patients with an HF diagnosis from 4 Veterans Affairs centers who had a Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score of less than 60 (heavy symptom burden and impaired functional status and quality of life) were enrolled between May 2009 and June 2011.
  
  
  METHODS
  The PCDM intervention included collaborative care by a multidisciplinary care team consisting of a nurse coordinator, cardiologist, psychiatrist, and primary care physician; home telemonitoring and patient self-management support; and screening and treatment for comorbid depression.
  
  
  METHODS
  The primary outcome was change in the KCCQ overall summary score at 1 year (a 5-point change is clinically significant). Mortality, hospitalization, and depressive symptoms (Patient Health Questionnaire 9) were secondary outcomes.
  
  
  RESULTS
  There were no significant differences in baseline characteristics between patients randomized to the PCDM intervention (n=187) vs usual care (n=197); baseline mean KCCQ overall summary scores were 37.9 vs 36.9 (P=.48). There was significant improvement in the KCCQ overall summary scores in both groups after 1 year (mean change, 13.5 points in each group), with no significant difference between groups (P=.97). The intervention was not associated with greater improvement in the KCCQ overall summary scores when the effect over time was estimated using 3-month, 6-month, and 12-month data (P=.74). Among secondary outcomes, there were significantly fewer deaths at 1 year in the intervention arm (8 of 187 [4.3%]) than in the usual care arm (19 of 197 [9.6%]) (P = .04). Among those who screened positive for depression, there was a greater improvement in the Patient Health Questionnaire 9 scores after 1 year in the intervention arm than in the usual care arm (2.1 points lower, P=.01). There was no significant difference in 1-year hospitalization rates between the intervention arm and the usual care arm (29.4% vs 29.9%, P=.87).
  
  
  CONCLUSIONS
  This multisite randomized trial of a multifaceted HF PCDM intervention did not demonstrate improved patient health status compared with usual care.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00461513.
authors.affiliation: Research, Geriatrics, Ambulatory Care, and Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver2Department of Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora3Denver-Seattle Center of Innovatio.
authors.forename: David B
authors.initials: DB
authors.lastname: Bekelman
authors.affiliation: Research, Geriatrics, Ambulatory Care, and Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver3Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Denver, Colorado.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Plomondon
authors.affiliation: Research, Geriatrics, Ambulatory Care, and Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver3Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Denver, Colorado.
authors.forename: Evan P
authors.initials: EP
authors.lastname: Carey
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sullivan
authors.affiliation: Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Denver, Colorado5Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Karin M
authors.initials: KM
authors.lastname: Nelson
authors.affiliation: Research, Geriatrics, Ambulatory Care, and Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver2Department of Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora.
authors.forename: Brack
authors.initials: B
authors.lastname: Hattler
authors.affiliation: Research, Geriatrics, Ambulatory Care, and Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver2Department of Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora.
authors.forename: Connor F
authors.initials: CF
authors.lastname: McBryde
authors.affiliation: Veterans Affairs Puget Sound Health Care System, Seattle, Washington6Department of Medicine, University of Washington, Seattle.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Lehmann
authors.affiliation: Richmond Veterans Affairs Medical Center, Richmond, Virginia.
authors.forename: Katherine
authors.initials: K
authors.lastname: Gianola
authors.affiliation: Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: Research, Geriatrics, Ambulatory Care, and Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver2Department of Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora3Denver-Seattle Center of Innovatio.
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
mesh_terms: D015897:Comorbidity; D017281:Cost of Illness; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000379:methods*; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome