Whole-person care is a new paradigm for serious illness, but few programs have been
robustly studied. We sought to test the effect of LifeCourse (LC), a person-centered
program for patients living with serious illness, on health-care utilization, care
experience, and quality of life, employing a quasi-experimental design with a Usual Care
(UC) comparison group. The study was conducted 2012 to 2017 at an upper-Midwest
not-for-profit health-care system with outcomes measured every 3 months until the end of
life. Enrolled patients (N = 903) were estimated to be within 3 years of end of life and
diagnosed with 1+ serious illness. Exclusion criteria included hospice enrollment at time
of screening or active dying. Community health workers (CHWs) delivered standardized
monthly 1-hour home visits based on palliative care guidelines and motivational
interviewing to promote patients’ physical, psychosocial, and financial well-being.
Primary outcomes included health-care utilization and patient- and caregiver-experience
and quality of life. Patients were elderly (LC 74, UC 78 years) and primarily
non-Hispanic, white, living at home with cardiovascular disease as the primary diagnosis
(LC 69%, UC 57%). A higher proportion of LC patients completed advance directives (N =
173, 38%) than UC patients (N = 66, 15%;
P
< .001). LifeCourse
patients who died spent more days in hospice (88 ± 191 days) compared to UC patients (44 ±
71 days;
P
= .018). LifeCourse patients reported greater improvements
than UC in communication as part of the care experience (
P
= .016).
Implementation of person-centered programs delivered by CHWs is feasible; inexpensive
upstream expansion of palliative care models can yield benefits for patients and
caregivers. Trial Registration: Trial NCT01746446 was registered on November 27, 2012 at
ClinicalTrials.gov
.