Depression in Palliative Care

2012 ◽  
Vol 69 (2) ◽  
pp. 99-106 ◽  
Author(s):  
Michaela Signer
Keyword(s):  
Palliative Care ◽  
Icd 10 ◽  
Palliative Betreuung

Depression ist eine häufige komorbide behandlungsbedürftige Störung, diedie Lebensqualität von Patienten und ihren Angehörigen erheblich beeinträchtigt. Phänomenologisch ist in palliativen Situationen ein breites Spektrum an Störungen anzutreffen, die es voneinander abzugrenzen gilt: "normal" zu wertende Reaktionen auf eine unheilbare Erkrankung wie Trauer, Wut und Verzweiflung bis hin zu schweren depressiven Störungen. Durch häufige Symptomüberschneidungen zwischen der somatischen Grunderkrankung und einer Depression sind die gängigen ICD-10-Kriterien zur Diagnosestellung Depression in der Palliative Care nicht anwendbar. Es empfiehlt sich, alle Symptome auszuschließen, die auch Folge der Grunderkrankung sein könnten. Durch eine adäquate palliative Betreuung als eines der wenigen Evidenz-basierten Elemente in der Betreuung palliativer Patienten mit Depression kann eine maximale Prävention erreicht werden. Bei der Therapieauswahl sollte neben dem Therapieziel die zu erwartende verbleibende Lebenszeit richtungweisend sein.

Analysis of health administration data to inform health service planning for paediatric palliative care

2020 ◽  
pp. bmjspcare-2020-002449
Author(s):  
Alison Pauline Bowers ◽  
Natalie Bradford ◽  
Raymond Javan Chan ◽  
Anthony Herbert ◽  
Patsy Yates
Keyword(s):  
Palliative Care ◽  
Health Service ◽  
Health Services ◽  
Hospital Admissions ◽  
Demographic Characteristics ◽  
Service Planning ◽  
Service Usage ◽  
Paediatric Palliative Care ◽  
Icd 10 ◽  
Limiting Condition

BackgroundHealth service planning in paediatric palliative care is complex, with the diverse geographical and demographic characteristics adding to the challenge of developing services across different nations. Accurate and reliable data are essential to inform effective, efficient and equitable health services.AimTo quantify health service usage by children and young people aged 0–21 years with a life-limiting condition admitted to hospital and health service facilities in Queensland, Australia during the 2011 and 2016 calendar years, and describe the clinical and demographic characteristics associated with health services usage.DesignRetrospective health administrative data linkage of clinical and demographic information with hospital admissions was extracted using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision Australian Modification (ICD-10-AM) diagnostic codes. Data were analysed using descriptive statistics.Setting/participantsIndividuals aged 0–21 years with a life-limiting condition admitted to a Queensland Public Hospital and Health Service or private hospital.ResultsHospital admissions increased from 17 955 in 2011 to 23 273 in 2016, an increase of 5318 (29.6%). The greatest percentage increase in admissions were for those aged 16–18 years (58.1%, n=1050), and those with non-oncological conditions (36.2%, n=4256). The greatest number of admissions by ICD-10-AM chapter for 2011 and 2016 were by individuals with neoplasms (6174, 34.4% and 7206, 31.0% respectively). Overall, the number of admissions by Indigenous children and young people increased by 70.2% (n=838).ConclusionsAdministrative data are useful to describe clinical and demographic characteristics and quantify health service usage. Available data suggest a growing demand for health services by children eligible for palliative care that will require an appropriate response from health service planners.

scholarly journals Prevalence of the Z515 (Palliative Care) Diagnosis from the ICD-10 System in Cancer Patients and the Relationship between Treatment and Cost in Songklanagarind Hospital

2018 ◽  
Vol 36 (4) ◽  
Author(s):  
Orapan Fumaneeshoat
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Average Cost ◽  
Data Extraction ◽  
Diagnostic System ◽  
Healthcare Services ◽  
Diagnostic Code ◽  
Icd 10 ◽  
The Government ◽  
The Relationship

Objective: To determine the prevalence of use of the diagnostic system ICD-10 code Z515 in patients diagnosed with cancer and the relationship between treatment and cost in Songklanagarind Hospital during the 2012-2016 period. Material and Methods: A retrospective descriptive study was performed in patients who were diagnosed as code Z515 in Songklanagarind Hospital from 2012-2016. Data were collected through the Hospital Information System (HIS), and the patients were divided into 2 groups based on whether they were Inpatient Department (IPD) or Outpatient Department (OPD). From the HIS, data concerning sex, age, the right of access to healthcare services, date of diagnosis, first and last department that diagnosed the Z515 code, other departments that diagnosed the same code, other codes diagnosed besides Z515, the latest treatment received, number of regularly-used medications, symptoms that persisted according to the most recent record, ward name, duration of hospitalization (for IPD cases), and the average cost of treatment were recorded on data extraction forms and analyzed as percentages with 95% confidence interval and odds ratios. Results: The prevalence of the diagnostic code Z515 in cancer patients during the study period was 0.2% in both inand outpatients. For outpatient the relationship between average cost and number of medications and average cost and type of treatment were statistically significantly different, while for inpatients the difference was not statistically significant. Conclusion: In Songklanagarind Hospital the use of code Z515 is very low, even though we know that all cancer patients should get the best palliative care support and the earlier we diagnose them as palliative, the better the care they will receive. Therefore, if the doctors are aware of this code, the patient will receive the best care in their end stages of life, and that would make them and their families feel happier. Moreover, our hospital will get reimbursement from the government to get more resources. Hence, more patients can be helped. Songklanagarind Hospital should undertake some kind of program to ensure all physicians are aware of code Z515 and how to use it in order to provide the best care for end-of-life patients.

scholarly journals Pädiatrische Palliative Care: was ist bei Kindern anders als bei Erwachsenen?

2018 ◽  
Vol 75 (2) ◽  
pp. 101-104 ◽  
Author(s):  
Eva Bergsträsser
Keyword(s):  
Palliative Care ◽  
Sich Eine ◽  
Eine Hohe ◽  
Palliative Betreuung

Zusammenfassung. Die Anzahl von Kindern und Jugendlichen (0 – 18 Jahre) mit lebenslimitierenden Erkrankungen und einem Bedarf für palliative Betreuung nimmt zu. Das Bewusstsein für diesen Umstand und den Bedarf hinken hingegen in der Schweiz verglichen mit anderen entwickelten Ländern hinterher. In der Schweiz kann die Anzahl von Kindern mit einem Bedarf für Palliative Care auf etwa 5’000 geschätzt werden. Dem gegenüber stehen etwa 500 Kinder (0 – 18 Jahre), die jährlich sterben. Die häufigsten Todesursachen sind Krankheiten und Geburtskomplikationen des Neugeborenen, die in den ersten vier Lebenswochen zum Tod führen, Folgen von Unfällen und eine Vielzahl lebenslimitierender Krankheiten. Im Vergleich zu Erwachsen zeichnen sich Kinder mit einem Bedarf für eine palliative Betreuung und Begleitung nicht nur durch ihre deutlich geringere Anzahl aus. In dieser Kleinheit und Seltenheit verbirgt sich eine hohe Heterogenität der Bedürfnisse, die Kinder mit palliativem Betreuungsbedarf markant von Erwachsenen unterscheidet.

Verification of administrative data to measure palliative care at terminal hospital stays

2020 ◽  
pp. 183335832096857
Author(s):  
Joanne M Stubbs ◽  
Hassan Assareh ◽  
Helen M Achat ◽  
Sally Greenaway ◽  
Poorani Muruganantham
Keyword(s):  
Palliative Care ◽  
Administrative Data ◽  
Diagnosis Code ◽  
Palliative Care Specialist ◽  
Comfort Care ◽  
Care Specialist ◽  
Syringe Driver ◽  
Icd 10 ◽  
Hospital Administrative ◽  
Hospital Administrative Data

Background: Administrative data and clinician documentation have not been directly compared for reporting palliative care, despite concerns about under-reporting. Objective: The aim of this study was to verify the use of routinely collected administrative data for reporting in-hospital palliation and to examine factors associated with coded palliative care in hospital administrative data. Method: Hospital administrative data and inpatient palliative care activity documented in medical records were compared for patients dying in hospital between 1 July 2017 and 31 December 2017. Coding of palliative care in administrative data is based on hospital care type coded as “palliative care” and/or assignment of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) palliative care diagnosis code Z51.5. Medical records were searched for specified keywords, which, read in context, indicated a palliative approach to care. The list of keywords (palliative, end of life, comfort care, cease observations, crisis medications, comfort medications, syringe driver, pain or symptom management, no cardiopulmonary resuscitation, advance medical plan/resuscitation plan, deteriorating, agitation, restless and delirium) was developed in consultation with seven local clinicians specialising in palliative care or geriatric medicine. Results: Of the 576 patients who died in hospital, 246 were coded as having received palliative care, either solely by the ICD-10-AM diagnosis code Z51.5 (42%) or in combination with a “palliative care” care type (58%). Just over one-third of dying patients had a palliative care specialist involved in their hospital care. Involvement of a palliative care specialist and a cancer diagnosis substantially increased the odds of a Z51.5 code (odds ratio = 11 and 4, respectively). The majority of patients with a “syringe driver” or identified as being at the “end of life” were assigned a Z51.5 code (73.5% and 70.5%, respectively), compared to 53.8% and 54.7%, respectively, for “palliative” or “comfort care.” For each keyword indicating a palliative approach to care, the Z51.5 code was more likely to be assigned if the patient had specialist palliative care input or if they had cancer. Conclusion: Our results suggest administrative data under-represented in-hospital palliative care, at least partly due to medical record documentation that failed to meet ICD-10-AM coding criteria. Collaboration between clinicians and coders can enhance the quality of records and, consequently, administrative data.

Palliative care and aggressive interventions after falling: A Nationwide Inpatient Sample analysis

2021 ◽  
pp. 1-6
Author(s):  
Vanessa P. Ho ◽  
Wyatt P. Bensken ◽  
Siran M. Koroukian
Keyword(s):  
Palliative Care ◽  
Nationwide Inpatient Sample ◽  
Feeding Tube ◽  
Tube Placement ◽  
Discharge Data ◽  
Future Goals ◽  
Care Services ◽  
Icd 10 ◽  
Palliative Care Services ◽  
Aggressive Interventions

Abstract Objective The purpose of this study is to identify whether there is an opportunity for improvement to provide palliative care services after a serious fall. We hypothesized that (1) palliative care services would be utilized in less than 10% of patients over the age of 65 who fall and (2) more than 20% of patients would receive aggressive life-sustaining treatments (LSTs) prior to death. Methods Using the 2017 Nationwide Inpatient Sample, we identified patients who were admitted to the hospital with a fall (ICD-10 W00-W19) and were hospitalized at least two days with valid discharge data. Palliative care services (Z51.5) or LSTs (cardiopulmonary resuscitation, ventilation, reintubation, tracheostomy, feeding tube placement, vasopressors, transfusion, total parenteral nutrition, and hemodialysis) were identified with ICD-10 codes. We examined the use of palliative care or LSTs by discharge destination (home, facility, and death). Logistic regression was used to identify factors associated with palliative care. Results In total, 155,241 patients were identified (median 82 years old, interquartile range 74–88); 2.5% died in hospital, and 69.4% were transferred to a facility. Palliative care occurred in 4.5% of patients, and LST occurred in 15.1%. Patients who died were significantly more likely to have had palliative care (50.1% vs. 3.4% of home or facility discharges) and were more likely to have an LST [53.0% vs. 9.8% (home) vs. 15.9% (facility)]. Palliative care was associated with both death [adjusted odds ratio (AOR) 19.84, 95% confidence interval (CI) 18.39–21.41, p < 0.001] and LST (AOR 1.36, 95% CI 1.27–1.46, p < 0.001). Significance of results Palliative care is associated with both death and LST, suggesting that physicians use palliative care as a last resort after aggressive measures have been exhausted. Patients who fall would likely benefit from the early use of palliative care to align future goals of care.

scholarly journals Palliative care of the patient with the brain cancer Astrocytoma GII/GIII – a case study

2013 ◽  
Vol 7 (4) ◽  
pp. 39-42
Author(s):  
Marta Gawlik ◽  
Donata Kurpas
Keyword(s):  
Palliative Care ◽  
Brain Cancer ◽  
Social Life ◽  
Combined Therapy ◽  
Symptomatic Treatment ◽  
Medical Documentation ◽  
Her Family ◽  
Vital Functions ◽  
The Family ◽  
Icd 10

Introduction: Malignant cancers of the central nervous system with the consequences of strong symptoms and urgent progression of the disease put the palliative teams of the palliative wards in the feeling of helplessness. Difficulties in undertaking the treatment and lack of experience with such patients cause their higher mortality rate. The main aim of the case: The aim of the study is to present the clinical treatment and the palliative care of the patient with Astrocytoma GII/GIII (ICD 10 C -71). Data and Methods: Analyses of the medical documentation, observation and nursing interview with the patient’s family were taken into account.Case study: A 39 year old woman, who had never been cured for cancer before, was transferred from the neurosurgery to the palliative care ward with brain cancer astrocytoma GII/GIII without any contact and lack of improvement of her condition. After a symptomatic treatment, a combined therapy was applied which consisted of oral chemotherapy (Lomustine) and radiotherapy. The patient’s condition was systematically improving. The patient and her family received care and support from the therapeutic team, which made it possible for the patient to return back home after eight months on the ward. It made the patient function alone and lead active social life despite of the limitations caused by cancer.Conclusions: It is not advisable to make quick decisions of ceasing the treatment only because of the diagnosis of inoperable brain malignant cancers. The therapeutic team play a significant role in the process of restoring the vital functions of the patient and in the entire therapy. Especially the family, who are the active members of the team, become very important. Education and the family support is essential and helps to tackle such a difficult chronic disease with bad prognosis. It also helps to understand specific symptoms and behaviours of the patients with brain cancer much better. Furthermore, it helps to lower the level of the family’s anxiety and frustration. Active cooperation of the family and the therapeutic team allows the patient to get back home AFVSS.

LO02: Heart failure and palliative care in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S27-S28
Author(s):  
M. Lipinski ◽  
D. Eagles ◽  
L.M. Fischer ◽  
L. Mielneczuk ◽  
I.G. Stiell
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
High Risk ◽  
Mortality Rate ◽  
Hospital Admissions ◽  
Mortality And Morbidity ◽  
Early Palliative Care ◽  
Icd 10 ◽  
Ed Visits ◽  
One Year

Introduction: Heart failure (HF) is a common ED presentation that is associated with significant morbidity and mortality. Despite recent evidence and recommendations for early palliative care (PC) involvement in these patients, they are still significantly under-served by PC services, often resulting in multiple ED visits. We sought to evaluate use of PC services in patients with HF presenting to the ED. Secondary objectives of the study were to investigate: 1) one year mortality, ED visits, and admissions; 2) application of a novel palliative care referral score. Methods: We conducted a health records review of 500 consecutive HF patients who presented to two academic hospital EDs. We included patients aged 65 years or older who were diagnosed as having a HF exacerbation by the emergency physician (ICD-10 code 150.-). Our primary outcome was PC involvement. Secondary outcomes included one year mortality rates, ED visits, admissions to hospital, as well as the application of a novel PC referral score developed by the institutional cardiac Palliative Care Committee. The score consisted of 6 different aspects of the patient’s illness, including laboratory tests, hospital usage, and markers of decompensation. We conducted appropriate univariate analyses. Results: Patients were mean age 80.7 years, women (53.2%), and had significant comorbidities (atrial fibrillation (51.2%), diabetes (40.4%) and COPD (20.8%)). Compared to those with no PC, the 79 (15.8%) patients with PC involvement had a higher one year mortality rate (70.9% vs. 18.8%, p&lt;0.0001), more ED visits/year for HF (0.82 vs. 0.52, p&lt;0.0001), and more hospital admissions/year for HF (1.4 vs. 0.85, p&lt;0.0001). Using the heart failure palliative care score criteria, 60 patients had scores &gt;=2. Compared to those with scores &lt;2, these patients had a higher 1-year mortality rate (50% vs. 24%, p&lt;0.0001) and more ED visits/year for HF (0.83 vs. 0.54, p&lt;0.01). Only 40.0% of these high risk patients had any PC involvement. Conclusion: We found that few HF patients had PC services involved in their care. Using this novel HF palliative care referral score, we were able to identify patients with a significantly greater risk of mortality and morbidity. This study provides evidence that the ED is an appropriate setting to identify and refer high risk HF patients who would likely benefit from earlier PC involvement and may be a future avenue for PC access for these patients.

scholarly journals Ten-year trends of utilizing palliative care and palliative procedures in patients with gastric Cancer in the United States from 2009 to 2018 - a nationwide database study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Moon Kyung Joo ◽  
Ji Won Yoo ◽  
Zahra Mojtahedi ◽  
Pearl Kim ◽  
Jinwook Hwang ◽  
...  
Keyword(s):  
United States ◽  
Gastric Cancer ◽  
Palliative Care ◽  
The United States ◽  
Hospital Charges ◽  
Annual Growth Rate ◽  
Nationwide Database ◽  
Palliative Care Consultation ◽  
Icd 10 ◽  
Care Consultation

Abstract Objectives Little is known about the current status and the changing trends of hospitalization and palliative care consultation of patients with gastric cancer in the United States. The aim of this study was to evaluate the changing trend in the number of hospitalization, palliative care consultation, and palliative procedures in the US during a recent 10-year period using a nationwide database. Methods This was a retrospective study that analyzed the National Inpatient Sample (NIS) database of 2009–2018. Patients aged more than 18 years who were diagnosed with a gastric cancer using International Classification of Diseases (ICD)-9 and 10 codes were included. Palliative care consultation included palliative care (ICD-9, V66.7; ICD-10, Z51.5) and advanced care planning (ICD-9, V69.89; ICD-10, Z71.89). Palliative procedures included percutaneous or endoscopic bypass, gastrostomy or enterostomy, dilation, drainage, nutrition, and irrigation for palliative purpose. Results and discussion A total of 86,430 patients were selected and analyzed in this study. Using a compound annual growth rate (CAGR) approach, the annual number of hospitalizations of gastric cancer patients was found to be decreased during 2009–2018 (CAGR: -0.8%, P = 0.0084), while utilization rates of palliative care and palliative procedures increased (CAGR: 9.3 and 1.6%, respectively; P < 0.0001). Multivariable regression analysis revealed that palliative care consultation was associated with reduced total hospital charges (−$34,188, P < 0.0001). Conclusion Utilization of palliative care consultation to patients with gastric cancer may reduce use of medical resources and hospital costs.

Abstract 14583: Palliative Care Services in Patients Admitted With Cardiogenic Shock in the United States: Frequency and Predictors of 30-day Readmission

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zekun Feng ◽  
Boback Ziaeian ◽  
Gregg C Fonarow
Keyword(s):  
Palliative Care ◽  
Cardiogenic Shock ◽  
The United States ◽  
Left Ventricular ◽  
Renal Diseases ◽  
Readmission Rates ◽  
Care Services ◽  
Icd 10 ◽  
Palliative Care Services ◽  
Dnr Orders

Introduction: Patients admitted with cardiogenic shock (CS) have high in-patient mortality and readmission rates. Palliative care services (PCS) may be underutilized in this population and the association with 30-day readmission and other predictive factors are unknown. Methods: Using the 2017 Healthcare Cost and Utilization Project’s National Readmission Database, we identified index admissions in patients with (1) CS (ICD-10-CM code R57.0) and (2) CS with PCS (ICD-10-CM code Z51.5). Patients with orthotopic heart transplant or left ventricular assist device were excluded. We compared differences in 30-day readmission outcomes and identified readmission predictors using logistic regression analysis. Results: Among 127,045 survey-weighted CS index admissions, inpatient mortality was 37.0%. In those survived (n=80,030), 21.0% (n=16,779) were readmitted within 30 days and 12.3% (n=9,841) had DNR orders (ICD-10-CM code Z66). Of 26,555 CS with PCS index admissions, 72.5% died inpatient. In those survived (n=7,285), 11.6% (n=844) were readmitted within 30 days and 61.2% (n=4,461) had DNR orders. From CS with PCS index admissions, mean age was 70.7; 39.2% were female; 50.0% discharged to skilled nursing facility and 33.9% discharged to home health care. The average time to readmission was 11.8 days with 36% of all readmissions within first 14 days. Primary causes of readmission were cardiac (47.7%) and infectious (13.7%). Predictors of 30-day readmission for CS group versus CS with PCS group are listed in table. Conclusions: Use of PCS in patient admitted with CS remains low at 8.6% in 2017. PCS and DNR orders were associated with lower risk of 30-day readmission. Those receiving PCS during index admission had lower readmission rates at 11.6%. In CS with PCS index admissions, cardiopulmonary and renal diseases were positive predictors while female gender, private insurance, private hospital and higher household income were negative predictors of 30-day readmission.

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