Advancing Access to Palliative Medicine Services Through a Multi-Centered Interdisciplinary Educational Collaborative: The Impact of Practice Improvement Projects (S739)

AbstractObjective:The purpose of this study was to assess the impact of a palliative medicine consultation on medical intensive care unit (MICU) and hospital length of stay, Do Not Resuscitate (DNR) designation, and location of death for MICU patients who died during hospitalization.Method:A comparison of two retrospective cohorts in a 17-bed MICU in a tertiary care university-affiliated hospital was conducted. Patients admitted to the MICU between January 1, 2003 and June 30, 2004 (N = 515) were compared to MICU patients who had had a palliative medicine consultation between January 1, 2005 and June 1, 2009 (N = 693). To control for disease severity, only patients in both cohorts who died during their hospitalization were considered for this study.Results:Palliative medicine consultation reduced time until death during the entire hospitalization (log-rank test,p < 0.01). Time from MICU admission until death was also reduced (log-rank test,p < 0.01), further demonstrating the impact of the palliative care consultation on the duration of dying for hospitalized patients. The intervention group contained a significantly higher percentage of patients with a DNR designation at death than did the control group (86% vs. 68%, χ2test,p < 0.0001).Significance of results:Palliative medicine consultation is associated with an increased rate of DNR designation and reduced time until death. Patients in the intervention group were also more likely to die outside the MICU as compared to controls in the usual care group.

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The impact of palliative medicine?

Palliative Medicine ◽

10.1191/026921699672664609 ◽

1999 ◽

Vol 13 (4) ◽

pp. 273-274 ◽

Cited By ~ 3

Author(s):

Irene J Higginson ◽

Alan M McGregor

Keyword(s):

Palliative Medicine ◽

The Impact

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The Impact of the Palliative Medicine Rotation On Housestaff Comfort Level With Death (765)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2011.12.243 ◽

2012 ◽

Vol 43 (2) ◽

pp. 459

Author(s):

Farheen Hasan

Keyword(s):

Palliative Medicine ◽

Comfort Level ◽

The Impact

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Trends in Published Palliative Care Research: A 15-Year Review

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120944863 ◽

2020 ◽

pp. 104990912094486

Author(s):

Ambereen K. Mehta ◽

Rishi Patel ◽

Dheer Patel ◽

Mellar P. Davis

Keyword(s):

Palliative Care ◽

Symptom Management ◽

Palliative Medicine ◽

The United States ◽

Management Journal ◽

Time Points ◽

Professional Degree ◽

Study Type ◽

The Impact ◽

Published Research

Background: There has been a call for palliative care (PC) published research to support the impact and need for more specialty PC services. Objective: The purpose of this study was to characterize research in PC over a 15-year period in 3 PC journals published in the United States. Design: The authors reviewed every issue of the Journal of Pain and Symptom Management, Journal of Palliative Medicine, and American Journal of Hospice and Palliative Medicine from 2004 through 2018. Studies included were original articles and brief reports. Study type (qualitative, quantitative), author (first and last), gender, and professional degree of the author (first and last) were recorded. Results: A total of 4881 articles were included in this study. The proportion of quantitative papers significantly increased across 3 time points from 63% to 67% to 78%. The proportion of women first authors increased across all 3 time points (54%, 2004-2008; 57%, 2009-2013; 60%, 2014-2018), and the proportion of women last authors increased across all time points (38%, 2004-2008; 44%, 2009-2013; 46%, 2014-2018). More than 40% of authors were physicians. Conclusions: Published PC studies are increasingly quantitative in design. Gender authorship is female dominant for the first authors and increasingly equal across genders for the last authors.

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The impact of a palliative medicine consultation service in medical oncology

Supportive Care in Cancer ◽

10.1007/s00520-002-0341-8 ◽

2002 ◽

Vol 10 (4) ◽

pp. 337-342 ◽

Cited By ~ 55

Author(s):

Jade Homsi ◽

Declan Walsh ◽

Kristine A. Nelson ◽

Susan B. LeGrand ◽

Mellar Davis ◽

...

Keyword(s):

Palliative Medicine ◽

Medical Oncology ◽

Consultation Service ◽

The Impact

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A quasi-experimental evaluation of an intervention to increase palliative medicine referral in the emergency department

Journal of Health Services Research & Policy ◽

10.1177/1355819619839087 ◽

2019 ◽

Vol 24 (3) ◽

pp. 155-163

Author(s):

Eoin Tiernan ◽

John Ryan ◽

Mary Casey ◽

Aine Hale ◽

Valerie O’Reilly ◽

...

Keyword(s):

Emergency Department ◽

Experimental Evaluation ◽

Palliative Medicine ◽

Propensity Scores ◽

Secondary Analysis ◽

Primary Analysis ◽

Referral Rates ◽

Palliative Care Consultation ◽

Quasi Experimental ◽

The Impact

Objective To evaluate a new intervention intended to increase referral rates from the emergency department (ED) to the palliative medicine service (PMS) in acute hospitals. Methods We conducted a quasi-experimental evaluation in an urban teaching hospital in Dublin, Ireland. Data were collected over two eight-week periods in November/December 2013 and May/June 2015, with the PALliative Medicine in the Emergency Department (PAL.M.ED.™) intervention implemented in the intervening period. All adults who were admitted to the hospital via the ED during the two time periods and who received a palliative care consultation during their hospital stay were included in the study. Our primary analysis evaluated the impact of PAL.M.ED.™ on PMS referral in the ED. Our secondary analysis evaluated the impact of PMS referral in the ED on length of stay (LOS) and utilization, compared to PMS referral later in the admission. We controlled for observed confounding between groups using propensity scores. Results PAL.M.ED.™ was associated with an increase in PMS referral in the ED ( p < 0.005; odds ratio: 10.5 (95%CI: 3.8 to 28.7)). PMS referral in the ED was associated with shorter hospital LOS ( p < 0.005; −10.9 days (95%CI: −17.7 to −4.1)). Conclusions Low PMS referral rates in the ED, and the poor outcomes for patients and hospitals that arise from admissions of those with serious illness, may be mitigated by a proactive intervention to identify appropriate patients at admission.

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Improving public sector knowledge sharing through communities of practice

VINE Journal of Information and Knowledge Management Systems ◽

10.1108/vjikms-08-2019-0115 ◽

2020 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Rasmus Jørgensen ◽

Kasper Edwards ◽

Enrico Scarso ◽

Christine Ipsen

Keyword(s):

Public Sector ◽

Communities Of Practice ◽

Knowledge Sharing ◽

Work Performance ◽

Content Type ◽

Practice Improvement ◽

Study Approach ◽

Development Framework ◽

The Impact

Purpose This paper aims to study the impact of intentionally developed communities of practice (CoPs) on knowledge sharing and practice improvement in an administrative public sector organisation (PSO). Design/methodology/approach A case study approach was used to analyse the impact of the CoPs intentionally developed by four different teams at a Danish PSO. The study applied a CoP development framework suggested by the literature to develop the CoPs. Findings Three out of the four CoPs were successfully developed, and they positively affected knowledge sharing and practice improvement. CoP participants engaged in conversations to explore individual ways of working, share knowledge and ultimately improve practice. Standardisation and boundary spanning were identified as contextual factors influencing the CoP activities. Research limitations/implications The findings verify the framework and contribute to a better understanding of the factors affecting the development of CoPs that positively impact knowledge sharing and practice improvements in a PSO context. Practical implications The study provides operations managers in PSOs with a framework for developing CoPs to improve work performance through better knowledge sharing among employees. Originality/value The paper provides case study evidence for the relevance of CoPs in PSO settings and highlights the necessity of investing resources in employee knowledge-sharing interactions.

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