Quasi-Experimental Evaluation of LifeCourse on Utilization and Patient and Caregiver Quality of Life and Experience.

Patients were not randomly assigned. LifeCourse patients were recruited from six area hospitals or care centers, usual care patients were recruited mainly from one separate hospital, and patients who declined LifeCourse were offered usual care. The groups differed at baseline in age, marital status, home living, primary diagnosis, palliative quality of life, and care experience, although statistical models adjusted for some of these variables. Only 10% of the identified eligible sample consented. Many participants died or dropped out, and survey return rates fell from 97% at baseline to 64% at 12 months and 15% at 30 months. Data collection team members were not blinded to treatment groups. LifeCourse included home visits, phone calls, standardized assessments, question sets, and motivational interviewing, while patients also received standard medical care, which could include palliative, care management, home care, and/or hospice services. The contribution of any single component cannot be separated. The study was done in one not-for-profit health system in the upper Midwest, with a mostly white and non-Hispanic sample, so the results may not apply to other settings or populations.

The authors declared no potential conflicts of interest. The Robina Foundation supported the design, methods, subject recruitment, data collections, analysis, and preparation of the article.

Do not read the advance directive and hospice findings as proof that LifeCourse reduced emergency, hospital, or intensive care use or that the care guide visits alone caused the effects. The primary utilization outcome was not significant, and patients also received standard medical care, which could include palliative, care management, home care, and/or hospice services, so the contribution of any single component cannot be separated.