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).
Design: Patients, continuously enrolled between July 1999, and March 2001, were randomly
assigned to the PhoenixCare program or a control group receiving usual MCO care.
Setting: Hospice of the Valley, Phoenix, Arizona.
Participants: Participants were 192 patients with chronic obstructive pulmonary disease
(COPD) or chronic heart failure (CHF), who had an estimated 2-year life expectancy.
Intervention: 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.
Outcome measures: 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.
Conclusion: 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.
