The After Discharge Care Management of Low Income Frail Elderly (AD-LIFE) Randomized Trial: Theoretical Framework and Study Design

Abstract

Interdisciplinary care management is advocated for optimal care of patients with many types of chronic illnesses; however, few models exist that have been tested using randomized trials. The purpose of this report is to describe the theoretical basis for the After Discharge Management of Low Income Frail Elderly (AD-LIFE) trial, which is an ongoing 2-group randomized trial (total n ¼ 530) to test a chronic illness management and transitional care intervention. The intervention is based on Wagner's chronic illness care model and involves comprehensive posthospitalization nurse-led interdisciplinary care management for low income frail elders with chronic illnesses, employs evidence-based protocols that were developed using the Assessing Care of Vulnerable Elders (ACOVE) guidelines, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. The primary aim of the AD-LIFE trial is to test a chronic illness management intervention in vulnerable patients who are eligible for Medicare and Medicaid. This model, with its standardized, evidence-based medical and psychosocial intervention protocols, will be easily transportable to other sites interested in optimizing outcomes for chronically ill older adults. If the results of the AD-LIFE trial demonstrate the superiority of the intervention, then this data will be important for health care policy makers.

Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review

“…This may well reflect an increasing attention for social issues of multimorbid patients. This is an important finding since the integration of medical and social services is advocated to optimize care for patients with multiple chronic conditions [11,87].…”

Measured outcomes of chronic care programs for older adults: a systematic review

“…Organization impacts were collected with three measures: employee satisfaction, staff turnover rates [ 15 ], and “teamness” [ 16 ]. Health service use, with seven distinct measures, was measured fairly uniformly through costs (direct/indirect) [ 17 ], emergency department visits [ 16 , 18 – 20 ], hospitalizations and re-hospitalizations [ 16 – 20 ], hospital bed days [ 16 ], nursing home admission [ 12 , 16 , 18 , 19 ], prescribed medications [ 19 ], and utilization of services (community, home care, specialist, etc.) [ 13 , 15 , 19 , 20 ].…”

“…Quality of care measures were the most diverse (eighteen distinct measures) and were collected through three methods: provider perspectives of quality, patient perspectives of quality, and patient-related care processes. Professional caregiver measures of quality of care were assessed through perceptions of collaboration [ 21 ], quality of medical management [ 18 ] and impact of programs on health behaviour [ 14 ], as well as by using tools such as the Primary Care Assessment Survey [ 16 ], and the Assessment of Chronic Illness Care tool [ 13 ]. Quality of care from the patient’s perspective was more common, including measures of satisfaction [ 12 , 15 , 16 , 18 , 21 ], access to care [ 18 ], coordination of care [ 17 ], patient involvement in decision-making [ 18 , 22 ], client-centred care [ 17 ], and provider performance [ 13 ].…”

Factors that influence physical function and emotional well-being among Medicare-Medicaid enrollees

“…13,14 AD-LIFE was a randomized control care management study that included adults 65 and older who were eligible for both Medicare and Medicaid, had 1 or more deficits in activities of daily living (e.g., bathing, dressing, preparation), 2 or more deficits in instrumental activities of daily living (e.g., medication administration, managing finances, transportation), and at least 1 chronic condition (e.g., arthritis, diabetes, hypertension). The secondary analysis study was approved by the Summa Health System's Institutional Review Board (IRB) and The University of Utah's IRB.…”