scholarly journals DIVERSITY IN HOSPICE AND END-OF-LIFE EXPERIENCES: THE INFLUENCE OF CHRONIC DISEASE AND SOCIOCULTURAL FACTORS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S790-S790
Author(s):  
David Russell ◽  
Elizabeth A Luth ◽  
Ruth Masterson Creber
Keyword(s):  
Heart Failure ◽  
Chronic Disease ◽  
End Of Life ◽  
Hospice Care ◽  
The United States ◽  
Sociocultural Factors ◽  
Diverse Range ◽  
Non Profit ◽  
Demographic Transitions ◽  
Hospice Patients

Abstract Hospice provides supportive and palliative services to persons nearing the end-of-life. Use of the Medicare hospice benefit has grown to cover nearly half of all Medicare decedents. Even more notably, hospice agencies now serve patients with a diverse range of terminal conditions, including those not traditionally served by hospices, such as dementia and heart failure. In addition to expanded use of hospice care by patients with multiple types of chronic disease, demographic transitions in the United States over the last several decades have also led to increased use of hospice services among patients with diverse socio-cultural and linguistic backgrounds. Limited research has identified the unique experiences of patients enrolled in hospice who have diagnoses of dementia and heart failure, or explored how socio-cultural factors act to influence the course and outcomes of hospice care. This symposium features interdisciplinary collaborations between academic researchers and clinical practitioners at a large non-profit hospice agency in a multicultural urban environment. These collaborations, which draw on multiple theoretical perspectives and research methodologies, shed new light on patient experiences in hospice and identify opportunities for improving care and comfort at end-of-life. Presentations will include an exploration of the unique symptoms and experiences of hospice patients with heart failure, an evaluation of a clinical program for heart failure hospice patients, an exploration of collaborative goal setting between patients-providers, and an examination of cultural health capital as it relates to race/ethnic and socioeconomic disparities in hospitalization among hospice patients, and factors for disenrollment among hospice patients with dementia.

Use of Medical Devices in Hospice for Symptom Management

2016 ◽  
Vol 33 (10) ◽  
pp. 929-934 ◽  
Author(s):  
Nidhi Shah ◽  
Peter Homel ◽  
Jennifer Breznay
Keyword(s):  
End Of Life ◽  
Medical Device ◽  
Medical Devices ◽  
Symptom Management ◽  
Hospice Care ◽  
The United States ◽  
Patient Controlled Analgesia ◽  
Sampling Weights ◽  
Hospice Patients ◽  
Device Use

Background: Home health services in the United States(US) have been on a rise. Hospice patients cope with diverse physical and pain symptoms; medical devices are used for symptom management to improve their quality-of-care at end-of-life. Objective: Using the National Home and Hospice Care Survey (NHHCS), the study summarizes medical device use for symptom management and tracks various demographic variables for home hospice patients. Methods: A cross-sectional analysis of data using the 2007 NHHCS was conducted. There were 4733 hospice discharges which corresponded to 2,505,011 individuals in US with sampling weights. The data was analyzed using chi square tests and confounding factors adjusted with logistic regression. Results: Eighty-nine percent of hospice discharges were evaluated for pain at first assessment. The regression model for pain at first assessment was significantly associated with use of patient controlled analgesia (OR = 1.82, 95% CI = 1.28, 2.59) and urinary catheters (OR = 1.16, 95% CI = 1.02, 1.33). Patient with dyspnea were associated with significant use of oxygen (OR = 3.00, 95% CI = 2.64, 3.40) and metered dose inhaler (OR = 2.43, 95% CI = 1.92, 3.07). There was negligible use of total parenteral nutrition (TPN) noted in the study. Conclusion: In conclusion, the study highlights medical device use in home hospice care for end-of-life symptom management. It noted the significant use of IV infusion pumps and patient controlled analgesia. Conversely, there is little use of TPN or CPAP in patients with anorexia or dyspnea. While missing data on critical symptom evaluations regrettably raises questions about the validity of the study, the NHHCS serves as an important reservoir of data on the growing population of home hospice patients.

Survey on Use of Palliative Radiotherapy in Hospice Care

2004 ◽  
Vol 22 (17) ◽  
pp. 3581-3586 ◽  
Author(s):  
Stephen Lutz ◽  
Carol Spence ◽  
Edward Chow ◽  
Nora Janjan ◽  
Stephen Connor
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Palliative Radiotherapy ◽  
The United States ◽  
Care Organization ◽  
Life Care ◽  
Oncology Patients ◽  
Hospice Patients ◽  
American Society

Purpose Radiation oncologists and hospice professionals both provide end-of-life care for oncology patients, and little has been written about the interface between these two groups of specialists. Hospice professionals were surveyed to assess the perceived need for palliative radiotherapy in the hospice setting, to investigate factors that limit the access of hospice patients to radiotherapy, and to suggest areas of future collaboration on education, research, and patient advocacy. Patients and Methods Members of the National Hospice and Palliative Care Organization (NHPCO) and American Society for Therapeutic Radiology and Oncology jointly authored a questionnaire to investigate the beliefs of hospice professionals toward the use of radiotherapy for oncology patients in hospice. The questionnaire was distributed to all NHPCO member institutions, and the results were compiled and statistically analyzed. Results Four hundred eighty of more than 1,800 surveyed facilities responded to the questionnaire. The findings suggest that the majority of hospice professionals feel that radiotherapy is important in palliative oncology and that radiotherapy is widely available in the United States. Yet less than 3% on average of hospice patients served by hospices responding to the survey actually received radiotherapy in 2002. The most common barriers to radiotherapy in hospice care include radiotherapy expense, transportation difficulties, short life expectancy, and educational deficiencies between the specialties. Conclusion Multiple barriers act to limit the use of palliative radiotherapy in hospice care. Finding ways to surmount these obstacles will provide opportunity for improvement in the end-of-life care of cancer patients.

Abstract 149: Care for Heart Failure Patients at the End of Life: Hospital Readmission and Mortality Amongst Heart Failure Patients Discharged to Hospice

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Haider J Warraich ◽  
Adam Devore ◽  
Haolin Xu ◽  
Roland Matsouaka ◽  
Paul Heidenreich ◽  
...  
Keyword(s):  
Heart Failure ◽  
End Of Life ◽  
Median Survival ◽  
Hospital Readmission ◽  
Discharge Rate ◽  
Care Plan ◽  
High Risk Population ◽  
White Race ◽  
Heart Failure Patients ◽  
Hospice Patients

Background: While 1 in 10 patients hospitalized with heart failure (HF) die within 30 days, end-of-life care for this high-risk population is not well described. Methods: We analyzed patients discharged alive from the Get With The Guidelines-HF registry between 2005-2014, linked to Medicare claims. We compared patients discharged to hospice to non-hospice “advanced HF” patients (ejection fraction ≤25% and either on inotropes, sodium ≤130, blood urea nitrogen ≥45 mg/dL, systolic blood pressure ≤90 mmHg or comfort measures) and to other GWTG-HF patients. Results: Of 121,990 US patients, hospice patients (n=4588, 2164 facility-based, 2424 home hospice) compared with advanced HF (n=4357) and others (113,045) were older (median age 86 years vs 78 years vs 81 years), more likely white race (88% vs 80% vs 82%), have intravenous loop diuretics used (74% vs 57% vs 63%), have an advanced care plan/surrogate decision maker discussed or documented (76% vs 62% vs 66%), had more dyspnea at rest (55% vs 46% vs 48%) and worse/unchanged symptoms at discharge (35% vs 2% vs 1%) (all p<0.01). Discharge to hospice increased from 2% (n=109) in 2005 to 5% (n=968) in 2014. Median survival in hospice was 11 days (25 th , 75 th percentile: 3, 65 days) compared with advanced HF (318 days) and others (754 days); 34% of patients discharged to a hospice facility and 12% to home hospice died in <3 days. (Figure) Median survival in hospice did not change significantly from 2005 to 2014. Hospital readmission at 30 days was 4% among hospice, 27% for advanced HF, and 22% for others. Median hospice discharge rate was 3.0 (0.7, 5.5). Hospice discharges had lower adjusted hazards of all-cause readmission (hospice compared with others: advanced HF odd ratio (OR) 0.15 (95% confidence interval (CI) 0.13-0.18), others OR 0.15 (95% CI 0.13-0.18). Hospice patients also had lower 6-month and 1-year readmission rate. Non-white race (OR 1.59 [95% CI 1.18-2.17]) and younger age (OR per 5 years 1.18 [95% CI 1.10-1.27)] were the strongest predictors of readmission from hospice. Conclusion: Hospice use in patients hospitalized with HF is limited but increasing. Few hospice patients are rehospitalized and almost a quarter die within 3 days of discharge. These findings may inform interventions to improve hospice care for HF patients.

Abstract 270: Emergency Service Use in Heart Failure Patients on Hospice

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Meredith A MacKenzie
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Emergency Service ◽  
Service Use ◽  
Hospice Care ◽  
Care Needs ◽  
Heart Failure Patients ◽  
Patients With Heart Failure ◽  
Hospice Patients

Introduction: Emergency service use should be almost non-existent among hospice patients, as hospice is intended to provide for all care needs at the end of life. Cancer patients comprise almost 50% of hospice patients nation-wide and have relatively low rates of emergency service use while on hospice care. Hospice enrollment has been steadily increasing among patients with heart failure, but concerns have been raised about how well hospice care meets these patients’ needs. Emergency service use is one indicator of how well heart failure patients’ needs are met on hospice. Objective: To explore whether emergency service use is higher among heart failure patients on hospice as compared to cancer patients on hospice and reasons for this potential disparity. Methods: This is a secondary analysis of the 2007 National Home and Hospice Care Survey (NHHCS). Only hospice patients with heart failure (n=311) and hospice patients with breast, prostate, colon or lung cancer (n=946) were included in the analysis. Emergency service use was measured by response to NHHCS question 73 (“did the patient use one or more types of emergent care?”) and includes the use of both emergency room and outpatient (urgicenter) services. Multiple logistic regression was used to examine the relationship between emergency service use and diagnosis. All analyses were adjusted for hospice length of stay, patient age, race/ethnicity, caregiver relationship, number of comorbidities, functional status, cognitive function and place of care. Results: Subjects (M age 75.3, SD 12.68) were 51% female and 89% white. The rate of emergency service use was 9.6% among the cancer patients and 17.36% among heart failure patients. Heart failure patients were almost two times more likely to utilize emergency services (OR 1.96, p<.002). Among the covariates examined, only hospice length of stay was significantly associated with emergency service use (p<.000), but did not appear to make a clinically significant difference (OR 1.003). Conclusions: While this study lends support to the hypothesis that heart failure patients suffer unmet care needs while on hospice, the nature of these unmet needs should be further explored. Outcome disparities have previously been suggested to be due to differences in age, comorbidities and functional status between the heart failure and cancer populations, but this study does not support that hypothesis. Hospice care plans unique to the heart failure patient should be considered.

Happiness at the End of Life: A Qualitative Study

2020 ◽  
pp. 104990912093985
Author(s):  
Anne O’Callaghan ◽  
Ben Bickford ◽  
Conor Rea ◽  
Antonio Fernando ◽  
Phillipa Malpas
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Hospice Care ◽  
Qualitative Interviews ◽  
Well Being ◽  
Natural World ◽  
The Internet ◽  
Present Moment ◽  
Hospice Patients ◽  
Health And Well Being

Background: Happiness is a core ingredient of health and well-being, yet relatively little is known about what happiness means for individuals near the end of life, and whether perceptions of happiness change as individuals approach the end of their lives. Aim: The aim of this study was to explore, through interviews, how individuals experiencing hospice care understood and conceptualized happiness. Design: Qualitative interviews with hospice patients were analyzed thematically. Setting/Participants: Adult patients (n = 20) in a New Zealand hospice who were receiving palliative care and who could give their informed consent were invited by hospice nurse coordinators to an interview. Results: Four themes emerged from analysis of the transcribed interviews. Participants defined happiness most frequently and in most depth in relation to connection with others. They identified being in the present moment, particularly in relation to nature, and that happiness had become less associated with money, status, or possessions. They had an attitude of determination to focus on what mattered now. Conclusion: Patients receiving palliative care were generally happy with their lives, appreciated the simpler aspects of life away from the material. There was a common exhortation to young people to avoid focusing too much on acquisition and the internet and to prioritize instead social connection and engagement with the natural world.

End-of-life Heart Failure Care in the United States

2015 ◽  
Vol 11 (4) ◽  
pp. 615-623 ◽  
Author(s):  
Jonathan Buggey ◽  
Robert J. Mentz ◽  
Anthony N. Galanos
Keyword(s):  
United States ◽  
Heart Failure ◽  
End Of Life ◽  
The United States ◽  
Heart Failure Care

scholarly journals Advancing Value-Based Models for Heart Failure

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Karen Joynt Maddox ◽  
William K. Bleser ◽  
Hannah L. Crook ◽  
Adam J. Nelson ◽  
Marianne Hamilton Lopez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Disease ◽  
Heart Association ◽  
The Elderly ◽  
The United States ◽  
Care Quality ◽  
Fee For Service ◽  
Learning Collaborative ◽  
Longitudinal Models ◽  
Payment Models

Heart failure (HF) is a leading cause of hospitalizations and readmissions in the United States. Particularly among the elderly, its prevalence and costs continue to rise, making it a significant population health issue. Despite tremendous progress in improving HF care and examples of innovation in care redesign, the quality of HF care varies greatly across the country. One major challenge underpinning these issues is the current payment system, which is largely based on fee-for-service reimbursement, leads to uncoordinated, fragmented, and low-quality HF care. While the payment landscape is changing, with an increasing proportion of all healthcare dollars flowing through value-based payment models, no longitudinal models currently focus on chronic HF care. Episode-based payment models for HF hospitalization have yielded limited success and have little ability to prevent early chronic disease from progressing to later stages. The available literature suggests that primary care-based longitudinal payment models have indirectly improved HF care quality and cardiovascular care costs, but these models are not focused on addressing patients’ longitudinal chronic disease needs. This article describes the efforts and vision of the multi-stakeholder Value-Based Models Learning Collaborative of The Value in Healthcare Initiative, a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University. The Learning Collaborative developed a framework for a HF value-based payment model with a longitudinal focus on disease management (to reduce adverse clinical outcomes and disease progression among patients with stage C HF) and prevention (an optional track to prevent high-risk stage B pre-HF from progressing to stage C). The model is designed to be compatible with prevalent payment models and reforms being implemented today. Barriers to success and strategies for implementation to aid payers, regulators, clinicians, and others in developing a pilot are discussed.

Informal Caregivers’ Perceptions of Needs From Hospice Providers: An Integrative Review

2019 ◽  
Vol 36 (12) ◽  
pp. 1114-1123
Author(s):  
Ruth Anne Engbers
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Interpersonal Skills ◽  
Hospice Care ◽  
Informal Caregivers ◽  
The United States ◽  
Easy Access ◽  
Life Care ◽  
The United Kingdom ◽  
Formal Services

Introduction: In the United States, informal caregivers (ICs) provide care to over 70% of patients at the end of life. Approximately 500 000 ICs contribute to the end-of-life care for patients in the United Kingdom. Hospice care is expanding worldwide to meet the needs of these ICs. Because ICs play an instrumental role in the provision of hospice services, and their perspective of their needs of formal services requires further clarity, the purpose of this review is to synthesize research that elucidates perceptions of ICs regarding their experiences with hospice providers. Methods: Twelve research studies regarding perceptions of informal hospice caregivers were obtained by searching CINAHL, PsycINFO, and MEDLINE databases. Results: Four primary themes emerged that describe what ICs perceive as beneficial contributions of hospice providers in aiding their caregiving: providing easy access to desired care, building up the caregiver, forming a relationship, and utilizing culturally relevant interpersonal skills. Conclusion: Particular attention must be paid to ensuring that the IC is acknowledged as an expert part of the team. Clearly explaining available services, creating better ways to ease the IC’s transition from caregiving to bereavement, and recruiting minority hospice providers are other important efforts that could improve the caregiving experience. The needs of ICs are complex, but by listening to their perspective, we can begin to clarify the best ways to aid them in their difficult job.

Abstract 150: Care for Heart Failure Patients at the End of Life: Hospital Readmission and Mortality Amongst Heart Failure Patients Discharged to Hospice

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Haider J Warraich ◽  
Adam DeVore ◽  
Haolin Xu ◽  
Roland Matsouaka ◽  
Paul Heidenreich ◽  
...  
Keyword(s):  
Heart Failure ◽  
End Of Life ◽  
Median Survival ◽  
Hospital Readmission ◽  
Discharge Rate ◽  
Care Plan ◽  
High Risk Population ◽  
White Race ◽  
Heart Failure Patients ◽  
Hospice Patients

Background: While 1 in 10 patients hospitalized with heart failure (HF) die within 30 days, end-of-life care for this high-risk population is not well described. Methods: We analyzed patients discharged alive from the Get With The Guidelines-HF registry between 2005-2014, linked to Medicare claims. We compared patients discharged to hospice to non-hospice “advanced HF” patients (ejection fraction ≤25% and either on inotropes, sodium ≤130, blood urea nitrogen ≥45 mg/dL, systolic blood pressure ≤90 mmHg or comfort measures) and to other GWTG-HF patients. Results: Of 121,990 US patients, hospice patients (n=4588, 2164 facility-based, 2424 home hospice) compared with advanced HF (n=4357) and others (113,045) were older (median age 86 years vs 78 years vs 81 years), more likely white race (88% vs 80% vs 82%), have intravenous loop diuretics used (74% vs 57% vs 63%), have an advanced care plan/surrogate decision maker discussed or documented (76% vs 62% vs 66%), had more dyspnea at rest (55% vs 46% vs 48%) and worse/unchanged symptoms at discharge (35% vs 2% vs 1%) (all p<0.01). Discharge to hospice increased from 2% (n=109) in 2005 to 5% (n=968) in 2014. Median survival in hospice was 11 days (25 th , 75 th percentile: 3, 65 days) compared with advanced HF (318 days) and others (754 days); 34% of patients discharged to a hospice facility and 12% to home hospice died in <3 days. (Figure) Median survival in hospice did not change significantly from 2005 to 2014. Hospital readmission at 30 days was 4% among hospice, 27% for advanced HF, and 22% for others. Median per-hospital hospice discharge rate over the study perior was 3% (1%, 6%). Hospice discharges had lower adjusted hazards of all-cause readmission (hospice compared with others: advanced HF odd ratio (OR) 0.15 (95% confidence interval (CI) 0.13-0.18), others OR 0.15 (95% CI 0.13-0.18). Hospice patients also had lower 6-month and 1-year readmission rate. Non-white race (OR 1.59 [95% CI 1.18-2.17]) and younger age (OR per 5 years 1.18 [95% CI 1.10-1.27)] were the strongest predictors of readmission from hospice. Conclusion: Hospice use in patients hospitalized with HF is limited but increasing. Few hospice patients are rehospitalized and almost a quarter die within 3 days of discharge. These findings may inform interventions to improve hospice care for HF patients.

Hospice Approach to Palliative Care

2018 ◽  
Author(s):  
Sriram Yennurajalingam
Keyword(s):  
United States ◽  
Palliative Care ◽  
Social Work ◽  
Physical Therapy ◽  
Life Expectancy ◽  
End Of Life ◽  
Nursing Care ◽  
Hospice Care ◽  
The United States ◽  
Medicare Part

For the provision of palliative care in the hospice setting in the United States, Medicare covers any care that is reasonable and necessary to manage palliative and hospice care at end of life. To be eligible for this Medicare hospice benefit, a beneficiary must be entitled to Medicare Part A and be certified by a physician to have a life expectancy of 6 months or less if the illness runs its expected course. Medicare covers medications, nursing care, and medical services including care by a physician, physical therapy, social work. This chapter briefly reviews the various aspects of the Medicare hospice benefit.

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