The Promoting Effective Advance Care for Elders (PEACE) randomized pilot study: theoretical framework and study...

Area of Science:

• Geriatrics
• Palliative Care
• Health Services Research

Background:

• Existing practice guidelines inadequately address homebound, chronically ill patients needing both geriatric and palliative care.
• These patients often have complex needs including chronic illness, functional decline, and polypharmacy.
• There is a need for integrated care models to support this vulnerable population.

Purpose of the Study:

• To describe the theoretical basis of the Promoting Effective Advance Care for Elders (PEACE) randomized pilot study.
• To test an in-home interdisciplinary care management intervention for geriatric/palliative care patients.
• To evaluate the feasibility and potential effectiveness of integrating palliative and geriatric approaches.

Main Methods:

• A 2-group randomized pilot study (n=80) involving new enrollees in Ohio's PASSPORT Medicaid waiver program.
• Intervention group received an in-home, interdisciplinary care management program based on Wagner's Chronic Care Model.
• Intervention combined palliative care (symptom management, psychosocial support, advance care planning) with geriatric medicine (function optimization, polypharmacy management).

Main Results:

• The study is ongoing; therefore, main results are not yet available.
• The theoretical framework and intervention design are described.
• The feasibility of implementing an integrated care model in a community-based setting is being assessed.

Conclusions:

• The PEACE study provides a model for integrated care for homebound, chronically ill elders.
• This approach aims to optimize function, manage symptoms, and support advance care planning.
• The model is designed for potential scalability to other sites serving similar populations.