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https://www.readbyqxmd.com/read/27720791/impact-of-palliative-care-screening-and-consultation-in-the-icu-a-multi-hospital-quality-improvement-project
#1
Robert J Zalenski, Spencer S Jones, Cheryl Courage, Denise R Waselewsky, Anna S Kostaroff, David Kaufman, Afzal Beemath, John Bronfman, James W Castillo, Hicham Krayem, Anthony Marinelli, Bradley Milner, Maria Teresa Palleschi, Mona Tareen, Sheri Testani, Ayman Soubani, Julie Walch, Judy Wheeler, Sonali Wilborn, Hanna Granovsky, Robert D Welch
CONTEXT: There are few multi-center studies that examine the impact of systematic screening for palliative care and specialty consultation in the ICU. OBJECTIVE: To determine the outcomes of receiving palliative care consultation (PCC) for patients who screened positive on palliative care referral criteria. METHODS: In a prospective quality assurance intervention with a retrospective analysis, the covariate balancing propensity score method was utilized to estimate the conditional probability of receiving a PCC and to balance important covariates...
October 5, 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/27559623/the-impact-of-hospice-services-in-the-care-of-patients-with-advanced-stage-nonsmall-cell-lung-cancer
#2
Kristy T Duggan, Sara Hildebrand Duffus, Ralph B D'Agostino, William J Petty, Nathan P Streer, Richard C Stephenson
INTRODUCTION: Prior research has shown that advanced stage nonsmall cell lung cancer (NSCLC) patients enrolled in hospice care receive less aggressive treatment at the end of life (EOL) without compromising survival. Our purpose was to profile the continuum of care of these patients, exploring the connection between hospice enrollment and quality indicators for excellence in EOL cancer care. METHODS: One hundred ninety-seven deceased stage IV NSCLC patients diagnosed between 2008 and 2010 at two separate tertiary care centers within the same county were identified...
August 25, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27531840/exploring-the-association-of-hospice-care-on-patient-experience-and-outcomes-of-care
#3
Ruth Kleinpell, Eduard E Vasilevskis, Louis Fogg, E Wesley Ely
OBJECTIVE: To examine the association of the use of hospice care on patient experience and outcomes of care. Promoting high-value, safe and effective care is an international healthcare imperative. However, the extent to which hospice care may improve the value of care is not well characterised. METHODS: A secondary analysis of variations in care was conducted using the Dartmouth Atlas Report, matched to the American Hospital Association Annual Survey Database to abstract organisational characteristics for 236 US hospitals to examine the relationship between hospice usage and a number of variables that represent care value, including hospital care intensity index, hospital deaths, intensive care unit (ICU) deaths, patient satisfaction and a number of patient quality indicators...
August 16, 2016: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/27367547/quality-of-end-of-life-care-provided-to-patients-with-different-serious-illnesses
#4
Melissa W Wachterman, Corey Pilver, Dawn Smith, Mary Ersek, Stuart R Lipsitz, Nancy L Keating
IMPORTANCE: Efforts to improve end-of-life care have focused primarily on patients with cancer. High-quality end-of-life care is also critical for patients with other illnesses. OBJECTIVE: To compare patterns of end-of-life care and family-rated quality of care for patients dying with different serious illnesses. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cross-sectional study was conducted in all 146 inpatient facilities within the Veteran Affairs health system among patients who died in inpatient facilities between October 1, 2009, and September 30, 2012, with clinical diagnoses categorized as end-stage renal disease (ESRD), cancer, cardiopulmonary failure (congestive heart failure or chronic obstructive pulmonary disease), dementia, frailty, or other conditions...
August 1, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27299952/the-impact-of-reported-hospice-preferred-practices-on-hospital-utilization-at-the-end-of-life
#5
Melissa D Aldridge, Andrew J Epstein, Abraham A Brody, Eric J Lee, Emily Cherlin, Elizabeth H Bradley
BACKGROUND: The Affordable Care Act requires hospices to report quality measures across a range of processes and practices. Yet uncertainties exist regarding the impact of hospice preferred practices on patient outcomes. OBJECTIVE: Assess the impact of 6 hospice preferred practices and hospice organizational characteristics on hospital utilization and death using the first national data on hospice preferred practices. DESIGN: Longitudinal cohort study (2008-2011) of Medicare beneficiaries (N=149,814) newly enrolled in a national random sample of hospices (N=577) from the National Hospice Survey (84% response rate) and followed until death...
July 2016: Medical Care
https://www.readbyqxmd.com/read/27266769/default-options-in-advance-directives-study-protocol-for-a-randomised-clinical-trial
#6
Nicole B Gabler, Elizabeth Cooney, Dylan S Small, Andrea B Troxel, Robert M Arnold, Douglas B White, Derek C Angus, George Loewenstein, Kevin G Volpp, Cindy L Bryce, Scott D Halpern
INTRODUCTION: Although most seriously ill Americans wish to avoid burdensome and aggressive care at the end of life, such care is often provided unless patients or family members specifically request otherwise. Advance directives (ADs) were created to provide opportunities to set limits on aggressive care near life's end. This study tests the hypothesis that redesigning ADs such that comfort-oriented care is provided as the default, rather than requiring patients to actively choose it, will promote better patient-centred outcomes...
2016: BMJ Open
https://www.readbyqxmd.com/read/27248056/impact-of-inpatient-palliative-care-on-treatment-intensity-for-patients-with-serious-illness
#7
Jay R Horton, R Sean Morrison, Elizabeth Capezuti, Jennifer Hill, Eric J Lee, Amy S Kelley
BACKGROUND: Palliative care is associated with decreased treatment intensity and improved quality for individual patients at the end of life, but little is known about how hospital-wide outcomes are affected by the diffusion of palliative care principles. OBJECTIVE: We examined the relationship between presence of palliative care programs and hospitals' average treatment intensity, as indicated by mean intensive care unit (ICU) length of stay (LOS) and days under Medicare hospice coverage, in the last six months of life among Medicare beneficiaries aged 67 and over with serious chronic illness...
September 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27161968/investigation-of-racial-disparities-in-early-supportive-medication-use-and-end-of-life-care-among-medicare-beneficiaries-with-stage-iv-breast-cancer
#8
Devon K Check, Cleo A Samuel, Donald L Rosenstein, Stacie B Dusetzina
PURPOSE: Early supportive care may improve quality of life and end-of-life care among patients with cancer. We assessed racial disparities in early use of medications for common cancer symptoms (depression, anxiety, insomnia) and whether these potential disparities modify end-of-life care. METHODS: We used 2007 to 2012 SEER-Medicare data to evaluate use of supportive medications (opioid pain medications and nonopioid psychotropics, including antidepressants/anxiolytics and sleep aids) in the 90 days postdiagnosis among black and white women with stage IV breast cancer who died between 2007 and 2012...
July 1, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/27091417/palliative-chemotherapy-affects-aggressiveness-of-end-of-life-care
#9
Chin-Chia Wu, Ta-Wen Hsu, Chun-Ming Chang, Cheng-Hung Lee, Chih-Yuan Huang, Ching-Chih Lee
INTRODUCTION: Although palliative chemotherapy during end-of-life care is used for relief of symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive end-of-life care and less use of hospice service. This is a population-based study of the association between palliative chemotherapy and aggressiveness of end-of-life care. PATIENTS AND METHODS: Using the National Health Insurance Research Database of Taiwan, we identified 49,920 patients with metastatic cancer who underwent palliative chemotherapy from January 1, 2009, to December 31, 2011...
June 2016: Oncologist
https://www.readbyqxmd.com/read/27033156/novel-data-sharing-between-a-comprehensive-cancer-center-and-a-private-payer-to-better-understand-care-at-the-end-of-life
#10
Sherri O Stuver, Kristen McNiff, BĂ©len Fraile, Oreofe Odejide, Gregory A Abel, Anton Dodek, Joseph O Jacobson
CONTEXT: Understanding end-of-life (EOL) care patterns is a prerequisite to improving the experience for cancer patients. EOL measures endorsed by the National Quality Forum (NQF) have been examined in older patients using Medicare claims. OBJECTIVES: To evaluate EOL care for patients treated at a comprehensive cancer center, using private payer claims data. METHODS: A retrospective cohort study was conducted of Dana-Farber Cancer Institute (DFCI) patients who died between July 2010 and December 2012, and were insured by Blue Cross Blue Shield of Massachusetts...
August 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/26968023/longitudinal-changes-in-icu-admissions-among-elderly-patients-in-the-united-states
#11
Michael W Sjoding, Hallie C Prescott, Hannah Wunsch, Theodore J Iwashyna, Colin R Cooke
OBJECTIVES: Changes in population demographics and comorbid illness prevalence, improvements in medical care, and shifts in care delivery may be driving changes in the composition of patients admitted to the ICU. We sought to describe the changing demographics, diagnoses, and outcomes of patients admitted to critical care units in the U.S. hospitals. DESIGN: Retrospective cohort study. SETTING: U.S. hospitals. PATIENTS: There were 27...
July 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/26914833/intensity-of-end-of-life-care-for-patients-with-myelodysplastic-syndromes-findings-from-a-large-national-database
#12
COMPARATIVE STUDY
Sean A Fletcher, Angel M Cronin, Amer M Zeidan, Oreofe O Odejide, Steven D Gore, Amy J Davidoff, David P Steensma, Gregory A Abel
BACKGROUND: As the population ages, the prevalence of myelodysplastic syndromes (MDS) will increase, and many patients with MDS will require end-of-life (EOL) care. Little is known about the intensity of EOL care received by patients with these malignancies. METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare database and standard EOL quality measures, we assessed the prevalence and predictors of intensive care unit (ICU) admission in the last 30 days of life, chemotherapy in the last 14 days of life, and hospice enrollment among MDS patients who were 65 years old or older and died between 2006 and 2011...
April 15, 2016: Cancer
https://www.readbyqxmd.com/read/26849002/making-the-case-for-palliative-care-at-the-system-level-outcomes-data
#13
Parag Bharadwaj, Karen M Helfen, Leo J Deleon, Douglas M Thompson, Jennifer R Ward, John Patterson, Sriram Yennurajalingam, Joe B Kim, Kathie S Zimbro, J Brian Cassel, Aaron D Bleznak
BACKGROUND: A recent trend in health care is to integrate palliative care (PC) programs across multiple hospitals to reduce variation, improve quality, and reduce cost. OBJECTIVE: The study objective was to demonstrate the benefits of PC for a system. METHODS: The study was a descriptive study using retrospective medical records in seven federated hospitals where PC developed differently before system integration. Measured were length of stay (LOS), mortality, readmissions, saved intensive care unit (ICU) days, cost avoidance, and hospice referrals...
March 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/26784776/family-perspectives-on-aggressive-cancer-care-near-the-end-of-life
#14
Alexi A Wright, Nancy L Keating, John Z Ayanian, Elizabeth A Chrischilles, Katherine L Kahn, Christine S Ritchie, Jane C Weeks, Craig C Earle, Mary B Landrum
IMPORTANCE: Patients with advanced-stage cancer are receiving increasingly aggressive medical care near death, despite growing concerns that this reflects poor-quality care. OBJECTIVE: To assess the association of aggressive end-of-life care with bereaved family members' perceptions of the quality of end-of-life care and patients' goal attainment. DESIGN, SETTING, AND PARTICIPANTS: Interviews with 1146 family members of Medicare patients with advanced-stage lung or colorectal cancer in the Cancer Care Outcomes Research and Surveillance study (a multiregional, prospective, observational study) who died by the end of 2011 (median, 144...
January 19, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/26768772/emergency-department-initiated-palliative-care-in-advanced-cancer-a-randomized-clinical-trial
#15
Corita R Grudzen, Lynne D Richardson, Pauline N Johnson, Ming Hu, Binhuan Wang, Joanna M Ortiz, Emmett A Kistler, Angela Chen, R Sean Morrison
Importance: The delivery of palliative care is not standard of care within most emergency departments (EDs). Objective: To compare quality of life, depression, health care utilization, and survival in ED patients with advanced cancer randomized to ED-initiated palliative care consultation vs care as usual. Design, Setting, and Participants: A single-blind, randomized clinical trial of ED-initiated palliative care consultation for patients with advanced cancer vs usual care took place from June 2011 to April 2014 at an urban, academic ED at a quaternary care referral center...
January 14, 2016: JAMA Oncology
https://www.readbyqxmd.com/read/26543069/the-evolution-of-an-inpatient-palliative-care-consultation-service-in-an-urban-teaching-hospital
#16
On Ying Liu, Theodore Malmstrom, Patricia Burhanna, Miriam B Rodin
BACKGROUND: Research on inpatient palliative medicine reports quality-of-life outcomes and selected "hard" outcomes including pain scores, survival, and readmissions. OBJECTIVE: This case study reports the evolution of an inpatient palliative consultation (IPC) team to show how IPC induces culture change in a hospital that previously had no palliative care. DESIGN: Retrospective chart review. SETTING: A Catholic university-affiliated, inner-city hospital...
November 5, 2015: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/26492211/high-intensity-of-end-of-life-care-among-adolescent-and-young-adult-cancer-patients-in-the-new-york-state-medicaid-program
#17
Jennifer W Mack, Kun Chen, Francis P Boscoe, Foster C Gesten, Patrick J Roohan, Maria J Schymura, Deborah Schrag
BACKGROUND: Little is known about the care that adolescent and young adult (AYA) cancer patients receive at the end of life (EOL). OBJECTIVE: To evaluate use of intensive measures and hospice and location of death of AYA cancer patients insured by Medicaid in New York State. DESIGN: Using linked patient-level data from the New York State Cancer Registry and state Medicaid program, we identified 705 Medicaid patients who were diagnosed with cancer between the ages of 15 and 29 in the years 2004-2011, who subsequently died, and who were continuously enrolled in Medicaid in the last 60 days of life...
December 2015: Medical Care
https://www.readbyqxmd.com/read/26286505/effect-of-hospice-care-on-quality-indicators-of-end-of-life-care-among-patients-with-liver-cancer-a-national-longitudinal-population-based-study-in-taiwan-2000-2011
#18
Yee-Hsin Kao, Jui-Kun Chiang
BACKGROUND: Quality of near end-of-life (EOL) care is typically evaluated using six accepted quality indicators (QIs). Research has yet to evaluate the quality of EOL care for liver cancer patients in Taiwan. We evaluated the effect of hospice care on the quality of EOL care for patients with advanced liver cancer. METHODS: Using claims data obtained from the Taiwan National Health Insurance Research Database, we analyzed the QIs of EOL care for patients who died between 2000 and 2011...
2015: BMC Palliative Care
https://www.readbyqxmd.com/read/26270522/measuring-end-of-life-care-in-oncology-practices-learning-from-the-care-of-the-dying
#19
Elizabeth Hahn, Catherine J Brady-Copertino, Barry R Meisenberg
BACKGROUND: There is increased interest among oncology and palliative professionals in providing appropriately timed hospice services for cancer patients. End of life (EoL) metrics have been included in oncology quality programs, but accurate EoL data and benchmarks are hard to obtain. OBJECTIVE: To improve EoL care by measuring patterns of care among recently deceased patients. METHODS: Care utilization among deceased patients was analyzed by using software integrated with patient electronic health records...
June 2015: Journal of Community and Supportive Oncology
https://www.readbyqxmd.com/read/26090871/hospice-care-for-children-with-cancer-where-do-these-children-die
#20
Rachel Thienprayoon, Simon C Lee, David Leonard, Naomi Winick
Hospice is an important provider of end of life care; many children who die of cancer enroll in hospice programs. How frequently such children remain in hospice to die at home, or disenroll from hospice and die in the hospital, has not been described. A child's location of death has important implications for quality of life and parental adaptation. This represents a subanalysis of a retrospective study of 202 consecutive oncology patients who died at a single center between January 1, 2006 and December 31, 2010...
July 2015: Journal of Pediatric Hematology/oncology
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