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Advanced care plan recording

Magnolia Cardona, Ebony T Lewis, Robin M Turner, Hatem Alkhouri, Stephen Asha, John Mackenzie, Margaret Perkins, Sam Suri, Anna Holdgate, Luis Winoto, Chan-Wei Chang, Blanca Gallego-Luxan, Sally McCarthy, Mette R Kristensen, Michael O'Sullivan, Helene Skjøt-Arkil, Anette A Ekmann, Hanne H Nygaard, Jonas J Jensen, Rune O Jensen, Jonas L Pedersen, Dorothy Breen, John A Petersen, Birgitte N Jensen, Christian Backer Mogensen, Ken Hillman, Mikkel Brabrand
BACKGROUND: Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments. METHODS: Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale...
March 6, 2018: Archives of Gerontology and Geriatrics
Alison M Mudge, Carol Douglas, Xanthe Sansome, Michael Tresillian, Stephen Murray, Simon Finnigan, Cheryl Ruth Blaber
OBJECTIVES: People with serious life-limiting disease benefit from advance care planning, but require active identification. This study applied the Gold Standards Framework Proactive Identification Guidance (GSF-PIG) to a general hospital population to describe high-risk patients and explore prognostic performance for 12-month mortality. METHODS: Prospective cohort study conducted in a metropolitan teaching hospital in Australia. Hospital inpatients on a single day aged 18 years and older were eligible, excluding maternity and neonatal, mental health and day treatment patients...
March 2, 2018: BMJ Supportive & Palliative Care
Tara Conway Copper, Donna B Jeffe, Fahd A Ahmad, George Abraham, Feliciano Yu, Brianna Hickey, David Schnadower
OBJECTIVES: Children with medical complexity (CMC) are at risk for poor outcomes during medical emergencies. Emergency information forms (EIFs) provide essential medical information for CMC during emergencies; however, they are not widely used. We sought to identify factors related to optimal care for CMC to inform development of EIFs for CMC. METHODS: We interviewed 26 stakeholders, including parents of CMC, healthcare providers, health information technology, and privacy compliance experts...
February 28, 2018: Pediatric Emergency Care
Michael Hoerger, Joseph A Greer, Vicki A Jackson, Elyse R Park, William F Pirl, Areej El-Jawahri, Emily R Gallagher, Teresa Hagan, Juliet Jacobsen, Laura M Perry, Jennifer S Temel
Purpose We describe the key elements of early palliative care (PC) across the illness trajectory and examine whether visit content was associated with patient-reported outcomes and end-of-life care. Methods We performed a secondary analysis of patients with newly diagnosed advanced lung or noncolorectal GI cancer (N = 171) who were randomly assigned to receive early PC. Participants attended at least monthly visits with board-certified PC physicians and advanced practice nurses at Massachusetts General Hospital...
February 23, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Lindsay A Edwards, Christine Bui, Antonio G Cabrera, Jill Ann Jarrell
OBJECTIVE: To improve outpatient advanced care planning (ACP) for adults with congenital/pediatric heart disease followed in a pediatric heart failure (HF) and transplant clinic through quality improvement (QI) methodology. DESIGN: A one-year QI project was completed. We conducted quarterly chart reviews and incorporated feedback from the providers to direct subsequent interventions. PATIENTS AND SETTING: Patients ≥18 years of age seen in the HF and Transplant Clinic for follow-up visit were included in analysis...
February 18, 2018: Congenital Heart Disease
Cara C Lewis, Ajeng Puspitasari, Meredith R Boyd, Kelli Scott, Brigid R Marriott, Mira Hoffman, Elena Navarro, Hannah Kassab
OBJECTIVE: Although tailored implementation methods are touted as superior to standardized, few researchers have directly compared the two and little guidance regarding the specific details of each method exist. Our study compares these methods in a dynamic cluster randomized trial seeking to optimize implementation of measurement based care (MBC) for depression in community behavioral health. This specific manuscript provides a detailed, replicable account of the components of each multi-faceted implementation method...
January 27, 2018: BMC Research Notes
Margaret A Kenna, Alexandria L Irace, Julie E Strychowsky, Kosuke Kawai, Devon Barrett, Juliana Manganella, Michael J Cunningham
Importance: Children with Klippel-Feil syndrome (KFS), characterized principally by abnormal fusion of 2 or more cervical vertebrae, may have many additional congenital anomalies. The overall prevalence of otolaryngologic manifestations among patients with KFS has not been previously characterized. Objective: To define the otolaryngologic diagnoses made and procedures performed in 95 patients with KFS, which, to our knowledge, is the largest series of this challenging patient population published to date...
January 25, 2018: JAMA Otolaryngology—Head & Neck Surgery
Kathryn Cappell, Vandana Sundaram, Annie Park, Parveen Shiraz, Ridhi Gupta, Patricia Jenkins, Vyjeyanthi S J Periyakoil, Lori Muffly
Background Allogeneic hematopoietic cell transplantation (HCT) is associated with significant morbidity and mortality, making advance care planning (ACP) and management especially important in this patient population. A paucity of data exists on the utilization of ACP amongst allogeneic HCT recipients, and the relationship between ACP and intensity of health care utilization in these patients. Methods We performed a retrospective review of patients receiving allogeneic HCT at our institution from 2008 to 2015 who had subsequently died following HCT...
January 22, 2018: Biology of Blood and Marrow Transplantation
Daniela Lamas, Natalie Panariello, Natalie Henrich, Bernard Hammes, Laura C Hanson, Diane E Meier, Nancy Guinn, Janet Corrigan, Sean Hubber, Hannah Luetke-Stahlman, Susan Block
OBJECTIVE: To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). BACKGROUND: Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation. However, there are no standards to guide ACP documentation in the electronic health record (EHR)...
January 23, 2018: Journal of Palliative Medicine
Oleg Kiriaev, Emme Chacko, J D Jurgens, Meagan Ramages, Phillipa Malpas, Gary Cheung
BACKGROUND: People with dementia receive worse end of life care compared to those with cancer. Barriers to undertaking advanced care planning (ACP) in people with dementia include the uncertainty about their capacity to engage in such discussions. The primary aim of this study was to compare the Advance Care Planning-Capacity Assessment Vignette tool (ACP-CAV) with a semi-structured interview adapted from the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). The secondary aim was to identify demographic and cognitive functioning variables that may predict whether a person has capacity to discuss ACP...
January 16, 2018: International Psychogeriatrics
Sebastiano Mercadante, Paolo Marchetti, Claudio Adile, Amanda Caruselli, Patrizia Ferrera, Andrea Costanzi, Alessandra Casuccio
BACKGROUND: A supportive palliative care unit (SPCU) may have a positive impact on patients' care. The aim of this study was to compare the pattern of patients admitted to a specialized SPCU and to a traditional oncologic ward (OW) in a consecutive sample of advanced cancer patients. METHODS: Data on patients demographics, reasons for and kind of admission, care-giver, anticancer treatments, being on/off treatment or uncertain, origin setting, who proposed hospital admission, the use of opioids, and hospitalization were gathered...
January 8, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Jean-Pierre Quenot, Fiona Ecarnot, Nicolas Meunier-Beillard, Auguste Dargent, Audrey Large, Pascal Andreu, Jean-Philippe Rigaud
A major goal of intensive care units (ICUs) is to offer optimal management, but for many patients admitted to the ICU, they are unlikely to yield any lasting benefit. In this context, the ICU physician remains a key intermediary, particularly when a decision regarding possible limitation or withdrawal of life-sustaining therapy becomes necessary. The possibility of admission to the ICU, and the type of care the patient would like to receive there, should be integrated into the healthcare project in agreement with the patient, regardless of the stage of disease that the patient suffers from...
December 2017: Annals of Translational Medicine
Jennifer Hopping-Winn, Juliette Mullin, Laurel March, Michelle Caughey, Melissa Stern, Jill Jarvie
Since 2013, Kaiser Permanente Northern California has engaged in a systematic effort to elicit, document, and honor the care preferences of patients as they near the end of life. This is done through its Advanced Steps program, in which selected patients discuss their preferences for future medical care with their healthcare agent during a structured conversation with a trained advance care planning facilitator. The facilitator then translates the patient's wishes into an actionable medical order set using a Physician's Order for Life-Sustaining Treatment (POLST) form...
January 3, 2018: Journal of Palliative Medicine
Jin Hyun Park, In Sil Choi, Ki Hwan Kim, Jin-Soo Kim, Kyung-Hun Lee, Tae-Yong Kim, Seock-Ah Im, Se Hyun Kim, Yu Jung Kim, Jee Hyun Kim
Purpose: Currently, there is little information regarding optimal treatment for metastatic breast cancer (MBC) in elderly patients. In this retrospective study, we examined a cohort of elderly patients with MBC receiving a range of treatments, in terms of demographic and clinicopathologic characteristics, treatment patterns, and outcomes. Methods: Patients aged 65 years and older, and diagnosed with MBC between 2003 and 2015, were identified from the databases of three academic hospitals in South Korea...
December 2017: Journal of Breast Cancer
Jennifer Webb, Asta Sorensen, Samantha Sommerness, Beth Lasater, Kamila Mistry, Leila Kahwati
BACKGROUND: The use of health information technology (IT) has been shown to promote patient safety in Labor and Delivery (L&D) units. The use of health IT to apply safety science principles (e.g., standardization) to L&D unit processes may further advance perinatal safety. METHODS: Semi-structured interviews were conducted with L&D units participating in the Agency for Healthcare Research and Quality's (AHRQ's) Safety Program for Perinatal Care (SPPC) to assess units' experience with program implementation...
December 19, 2017: BMC Medical Informatics and Decision Making
Ben A Blomberg, Rebekah C Mulligan, Stephen J Staub, Laura C Hanson, Margaret A Drickamer, Maureen C Dale
OBJECTIVES: To improve assessment and documentation of function, cognition, and advance care planning (ACP) in admission and discharge notes on an Acute Care of the Elderly (ACE) unit. DESIGN: Continuous quality improvement intervention with episodic data review. SETTING: ACE unit of an 866-bed academic tertiary hospital. PARTICIPANTS: Housestaff physicians rotating on the ACE unit (N = 31). INTERVENTION: Introduction of templated notes, housestaff education, leadership outreach, and posted reminders...
February 2018: Journal of the American Geriatrics Society
Michael J Rouse, CoraLynn B Trewet, Kristin K Janke
OBJECTIVES: The objectives of this commentary are to: 1) describe advancements in the continuing professional development (CPD) model over the past decade; 2) detail an updated CPD cycle; and 3) describe how practitioners' adoption of the CPD approach may facilitate the advancement of pharmacy practice. SUMMARY: CPD is a self-directed, ongoing, systematic, and outcomes-focused approach to an individual's lifelong learning that is applied into practice. The 6 components of reflect, plan, learn, evaluate, apply, and record + review, described in a revised depiction of the CPD cycle, have evolved over the past 10 years alongside the evolution of the profession of pharmacy...
December 12, 2017: Journal of the American Pharmacists Association: JAPhA
Abigail S Thomas, Kelley M Kidwell, Joseph K Oppong, Ernest K Adjei, Ernest Osei-Bonsu, Angela Boahene, Evelyn Jiggae, Kofi Gyan, Sofia D Merajver
Purpose Breast cancer, the most common cancer worldwide, is the leading cause of cancer mortality in Ghanaian women. Previous studies find Ghanaian women are diagnosed at a younger age and at more advanced stages (III and IV), and have tumors with characteristics similar to African American women. We sought to remedy gaps in knowledge about breast cancer survival in Ghana and its relation to demographic and biologic factors of the tumors at diagnosis to assist in cancer control and registration planning. Methods Individuals with a breast cancer diagnosis who sought care at Komfo Anokye Teaching Hospital from 2009 to 2014 were identified via medical records...
December 2017: Journal of Global Oncology
Jeffrey D Hoffmann, Nicholas A Kusnezov, John C Dunn, Nicholas J Zarkadis, Gens P Goodman, Richard A Berger
BACKGROUND: Hip and knee arthroplasties length of stay continues to shorten after advances in perioperative and intraoperative management, as well as financial incentives. Some authors have demonstrated good results with outpatient arthroplasty, but safety and general feasibility of such procedures remain unclear. Our hypothesis is that outpatient arthroplasty would demonstrate higher readmission and complication rates than inpatient arthroplasty. METHODS: We performed a systematic review of all publications on outpatient arthroplasty between January 1, 2000 and June 1, 2016...
November 22, 2017: Journal of Arthroplasty
Jason T Schaffer, Erik P Hess, Judd E Hollander, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Jonathan Inselman, Jeph Herrin, Victor M Montori, Nilay D Shah
BACKGROUND: Patients at low risk for acute coronary syndrome are frequently admitted for observation and cardiac testing, resulting in substantial burden and cost to the patient and the health care system. OBJECTIVES: The purpose of this investigation was to measure the effect of the Chest Pain Choice (CPC) decision aid on overall health care utilization as well as utilization of specific services both during the index emergency department (ED) visit and in the subsequent 45 days...
March 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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