title: Rationale and study design of a patient-centered intervention to improve health status in chronic heart failure: The Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) randomized trial.
abstract: While contemporary heart failure management has led to some improvements in morbidity and mortality, patients continue to report poor health status (i.e., burdensome symptoms, impaired function, and poor quality of life). The Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) trial is a NIH-funded, three-site, randomized clinical trial that examines the effect of the CASA intervention compared to usual care on the primary outcome of patient-reported health status at 6months in patients with heart failure and poor health status. The CASA intervention involves a nurse who works with patients to treat symptoms (e.g., shortness of breath, fatigue, pain) using disease-specific and palliative approaches, and a social worker who provides psychosocial care targeting depression and adjustment to illness. The intervention uses a collaborative care team model of health care delivery and is structured and primarily phone-based to enhance reproducibility and scalability. This article describes the rationale and design of the CASA trial, including several decision points: (1) how to design a patient-centered intervention to improve health status; (2) how to structure the intervention so that it is reproducible and scalable; and (3) how to systematically identify outpatients with heart failure most likely to need and benefit from the intervention. The results should provide valuable information to providers and health systems about the use of team care to manage symptoms and provide psychosocial care in chronic illness.
authors.affiliation: Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA; Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA. Electronic address: david.bekelman@va.gov.
authors.forename: David B
authors.initials: DB
authors.lastname: Bekelman
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Peterson
authors.affiliation: Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Brack
authors.initials: B
authors.lastname: Hattler
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA; Denver Health and Hospital Authority, Denver, CO, USA.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Havranek
authors.affiliation: University of Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Diane L
authors.initials: DL
authors.lastname: Fairclough
authors.affiliation: Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA; Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Connor F
authors.initials: CF
authors.lastname: McBryde
authors.affiliation: College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Meek
mesh_terms: D002908:Chronic Disease; D003863:Depression / Q000523:psychology / Q000628:therapy; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D000066498:Emotional Adjustment; D005221:Fatigue / Q000209:etiology / Q000628:therapy; D006304:Health Status; D006333:Heart Failure / Q000150:complications / Q000523:psychology / Q000628:therapy*; D006801:Humans; D009726:Nurses; D059408:Pain Management; D010166:Palliative Care; D000071066:Patient Reported Outcome Measures; D018802:Patient-Centered Care / Q000379:methods*; D011788:Quality of Life; D000068217:Social Workers
keywords: Heart failure; Palliative care; Patient-reported outcome; Psychosocial care; Quality of life; Randomized clinical trial