Outcome evaluation of a randomized trial of the PhoenixCare intervention: Program of case management and coordinated care for the seriously chronically ill

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 case-managers, 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 care-focused case management with ongoing MCO-based treatment was associated with improved functioning of chronically severely ill patients in the last years of life.