LifeCourse: A Supportive Care Approach for Patients Late in Life

Study Overview
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Brief Summary
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The purpose of the study is to test a new model of care for patients with an ongoing or significant medical condition.

Detailed Description
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LifeCourse is a late life care approach that promotes whole person care through a structured approach built upon an expanded set of palliative care domains and chronic illness care practices. It includes a trained lay healthcare worker as the primary contact who follows the patient across care settings and over time. The care guide asks patients and caregivers to articulate individualized goals and take part in decision making, and uses a family-oriented approach to understand needs, leverage strengths, and empower families to effectively support the individual living with serious illness.

Official Title
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LifeCourse: A Supportive Care Approach for Patients Late in Life

Conditions
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Ongoing or Significant Medical Condition

Intervention / Treatment
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* Other: Care team


Participation Criteria
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Eligibility Criteria
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Inclusion criteria Patient has an Allina Health primary or specialty provider Patient's medical chart indicates an on-going or significant medical condition LifeCourse will invite vulnerable patients to enroll, including: Critically ill patients Cognitively impaired patients Elderly patients, some of whom may have cognitive impairment and/or be institutionalized Exclusion Criteria Patient resides in a zip code which does not lie partially within a 45 mile radius from the Allina Health Commons in Minneapolis, Minnesota. Patient has not visited an Allina facility, affiliate, or community partner within the last year. Patient is eligible for hospice. Patient is actively dying. Patient is abusive or is discharged against medical advice (AMA).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Care team<br>Patients are offered the support and services of the care team. | Other: Care team<br>* Provides additional support to patients, family, and friends.<br>|
| No Intervention: Usual Care<br>Patients receive usual care. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Quality of Life | Patient QOL was measured using the Functional Assessment of Chronic Illness Therapy-Palliative v4 (FACIT-Pal) survey, a general measure of health-related QOL in 4 domains: physical, social, emotional, and functional, plus a measure of end-of-life experiences. Items were reverse scored according to scoring guidelines and domain scores were calculated via prorated scores when there were <50% missing items for a given domain and <20% missing domains for a total score. | Change from baseline survey responses at 3 month intervals until subject withdrawal or date of death from any cause, whichever comes first, up to six years. | 
| Patient Care Experience | Patient care experience was collected via a previously validated survey tool focused on the patient's experience with their care team in the last 30 days. Three domains were scored: care team, goals, and communication with prorated scores when there were <50% missing items for a given domain and <20% missing domains for a total score. | Change from baseline survey responses at 3 month intervals until subject withdrawal or date of death from any cause, whichever comes first, up to six years. | 
| Caregiver care experience | Caregiver care experience was measured by a developed tool, addressing various aspects of care experience. An overall score was calculated by summing answers to all items. Scores were also calculated in 3 domains: care team, communication, and support. | Change from baseline survey responses at 3 month intervals until subject withdrawal or date of death from any cause, whichever comes first, up to six years. | 
| Caregiver Quality of Life | aregiver QOL was assessed via the patient-reported outcomes measurement information system (PROMIS) which asks caregivers to report their QOL in 8 domains. The PROMIS-29 scores were calculated by summing answers to all items within each domain. | Change from baseline survey responses at 3 month intervals until subject withdrawal or date of death from any cause, whichever comes first, up to six years. |