Life In The Slower Lane

Here is the structured PICO analysis for the sixty-seventh article you uploaded:

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Full Title (verbatim and exact):

“Results of the Promoting Effective Advance Care Planning for Elders (PEACE) Randomized Pilot Study”

Radwany SM, Hazelett SE, Allen KR, et al.

Population Health Management (2014); 17(2):106–111

DOI: 10.1089/pop.2013.0017

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Type of Article:

Randomised pilot study (community-based interdisciplinary care management intervention)

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PICO Analysis:

Population:

• 80 older adults (>60 years) newly enrolled in Ohio’s PASSPORT Medicaid home care waiver program
• Community-dwelling, chronically ill, low-income individuals eligible for nursing home placement
• Conditions included: CHF, COPD, diabetes with complications, cancer, renal disease, Parkinson’s, etc.
• Exclusions: severe psychiatric illness, active substance use, cognitive impairment, or existing hospice enrolment 

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Intervention:

PEACE (Promoting Effective Advance Care Planning for Elders) program:

• Delivered by trained PASSPORT care managers in collaboration with a hospital-based geriatrics/palliative care team and the consumer’s primary care physician (PCP)
• Components included:
  • 2 in-home biopsychosocial assessments
  • Interdisciplinary team case review
  • Individualised, evidence-based care plan
  • Monthly care manager follow-up for 12 months
  • Emphasis on advance care planning, symptom management, patient activation, and self-management support
  • POLST completion (non-binding in Ohio but used for structured ACP conversations) 

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Comparator:

• Usual PASSPORT care, which focuses on psychosocial needs only
• Participants received monthly palliative care educational materials but no formal interdisciplinary input or ACP facilitation

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Outcome:

1. Person-centred outcomes:

• Measured using validated tools, but no statistically significant differences were observed:
  • Symptom management: Condensed Memorial Symptom Assessment Scale
  • Quality of life: QUAL-E scale
  • Mood: Hospital Anxiety and Depression Scale
  • Decision-making/care planning: Palliative Outcome Scale
  • Spirituality: Meaning in Life Scale
• Trends favoured the intervention group but with wide confidence intervals including zero 

2. Process outcomes:

• ACP uptake:
  • Durable Power of Attorney completion was higher in the intervention group (78% vs 58%; p = 0.077 – not statistically significant but suggestive)
• Monthly follow-ups and regular contact maintained across the year
• Intervention feasibility confirmed through strong retention and high care manager engagement despite full caseloads 

3. Health system outcomes:

• Health care utilisation at 12 months (Table 4):
  • ED visits: no difference (25% both groups)
  • Hospitalisations: 50% (intervention) vs 55% (control), p = 0.65
  • Permanent nursing facility placement: 22.5% (intervention) vs 32.5% (control), p = 0.32
• Although not statistically significant, trends suggested reduced hospital and nursing home use
• Estimated cost of intervention: $942/person/year; estimated savings from reduced hospital and nursing home use: $1065–$7115/person/year, depending on level of care avoided 

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Summary Conclusion:

The PEACE pilot demonstrated the feasibility of a home-based, interdisciplinary care management model integrating palliative care principles and advance care planning into Medicaid-funded long-term care. While clinical outcomes were not significantly improved, likely due to small sample size and tools not sensitive to early-stage intervention impact, trends suggest potential reductions in hospitalisation and nursing facility placement. The study supports further research using better-aligned outcome measures and a fully powered RCT. It also highlights the need for dedicated ACP-trained care managers and the importance of structured, ongoing collaboration between community agencies, PCPs, and hospital-based teams.

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