scholarly journals Improving the delivery of palliative care through predictive modeling and healthcare informatics

2021 ◽  
Author(s):  
Dennis H Murphree ◽  
Patrick M Wilson ◽  
Shusaku W Asai ◽  
Daniel J Quest ◽  
Yaxiong Lin ◽  
...  
Keyword(s):  
Palliative Care ◽  
Metastatic Cancer ◽  
Symptom Burden ◽  
Care Team ◽  
Care Hospital ◽  
Clinical Workflow ◽  
Electronic Health Record Data ◽  
Large Hospital ◽  
Hospital Patients ◽  
Holdout Validation

Abstract Objective Access to palliative care (PC) is important for many patients with uncontrolled symptom burden from serious or complex illness. However, many patients who could benefit from PC do not receive it early enough or at all. We sought to address this problem by building a predictive model into a comprehensive clinical framework with the aims to (i) identify in-hospital patients likely to benefit from a PC consult, and (ii) intervene on such patients by contacting their care team. Materials and Methods Electronic health record data for 68 349 inpatient encounters in 2017 at a large hospital were used to train a model to predict the need for PC consult. This model was published as a web service, connected to institutional data pipelines, and consumed by a downstream display application monitored by the PC team. For those patients that the PC team deems appropriate, a team member then contacts the patient’s corresponding care team. Results Training performance AUC based on a 20% holdout validation set was 0.90. The most influential variables were previous palliative care, hospital unit, Albumin, Troponin, and metastatic cancer. The model has been successfully integrated into the clinical workflow making real-time predictions on hundreds of patients per day. The model had an “in-production” AUC of 0.91. A clinical trial is currently underway to assess the effect on clinical outcomes. Conclusions A machine learning model can effectively predict the need for an inpatient PC consult and has been successfully integrated into practice to refer new patients to PC.

Evaluating the impact of early versus late inpatient palliative care consultation for cancer patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6638-6638
Author(s):  
Brian Cassel ◽  
Patrick J. Coyne ◽  
Nevena Skoro ◽  
Kathleen Kerr ◽  
Egidio Del Fabbro
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Palliative Care Team ◽  
Care Team ◽  
Care Hospital ◽  
Palliative Care Consultation ◽  
Social Security Death Index ◽  
Hospital Deaths ◽  
Care Consultation ◽  
The Impact

6638 Background: Access to specialist palliative care (hospital-based or hospice) is a recognized measure of quality in cancer care. Most cancer centers do have palliative care consult services, although the availability of a comprehensive program that includes a palliative care unit and outpatient clinic (Hui 2010) is inconsistent. A simultaneous integrated model of palliative care that facilitates earlier access to a specialized palliative care team may improve clinical outcomes. Palliative care programs should measure the access, timing and impact of their clinical service. Methods: Hospital claims data were linked to Social Security Death Index (SSDI) data from the US Department of Commerce. 3,128 adult cancer patients died between January 2009 and July 2011 and had contact with our inpatient palliative care team in their last six months of life. We determined whether IPC earlier than 1 month prior to death had an impact on hospitalizations, in-hospital mortality and referral to hospice. Results: 27.5% of cancer decedents accessed IPC, median of 22 days before death. 13.2% were discharged to hospice, median of 13 days before death. Patients with IPC earlier than 1 month until death were more likely to have hospice and fewer in-hospital deaths but there was no association between early IPC and a 30-day mortality admission. Conclusions: Palliative care services are accessed by a minority of patients and typically in the last 2-3 weeks of life. Although in-hospital deaths were reduced by earlier palliative care consultation, 30 day mortality did not improve. Hospitals may need to implement other strategies including early integration of outpatient palliative care among cancer patients, to achieve an impact on 30-day mortality admissions. [Table: see text]

Palliative Cancer Care: An Epidemiologic Study

2011 ◽  
Vol 29 (6) ◽  
pp. 646-650 ◽  
Author(s):  
Gerhild Becker ◽  
Isaak Hatami ◽  
Carola Xander ◽  
Bettina Dworschak-Flach ◽  
Manfred Olschewski ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Care ◽  
Medical Center ◽  
Metastatic Cancer ◽  
Epidemiologic Study ◽  
Care Needs ◽  
Patients With Cancer ◽  
Discharge Management ◽  
Hospital Patients ◽  
Definition Of

Purpose To analyze the need for palliative care in hospital patients who have cancer. Palliative care is an essential component of comprehensive cancer care and identification of palliative care needs (PCNs) of patients with cancer is a topic that has not been thoroughly studied. Patients and Methods Data were collected prospectively from inpatients of University Medical Center Freiburg in Freiburg, Germany, with 982 hospital beds included in the study. During the observation period of 17 months, each patient discharged from a hospital ward was screened by surveying the treating physician who was responsible for dismissal about patients' PCNs based on the WHO 1990 definition of palliative care. To complete obligatory electronic discharge management, a modified dismissal form asking to classify the patient as having PCN “yes/no” had to be filled out for each patient discharged. Results The response rate was 96% with data for 39,849 patients that could be analyzed. A total of 6.9% of all hospital patients and 9.1% of patients older than age 65 years were considered to have PCNs. Of the 2,757 patients with PCNs, 67% (n = 1,836) had cancer. Among the 11,584 patients with cancer, 15.8% were classified as having PCNs. PCNs were particularly high in patients with head and neck cancer (28.3%), malignant melanoma (26.0%), and brain tumors (18.2%). Suffering from cancer increases the probability of developing PCNs by a factor of 3.63 (95% CI, 3.27 to 4.04). For patients with metastatic cancer, the risk of developing PCNs is increased 12-fold (odds ratio, 12.27; 95% CI, 11.07 to 13.60). Conclusion Structures to provide palliative care for patients with cancer are needed.

Abstract 262: Preferences for Primary versus Specialty Palliative Care Among Patients With Heart Failure

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Dara Z Ikejiani ◽  
Rachel A Hadler ◽  
Robert M Arnold ◽  
David Bekelman ◽  
Laura T Moreines ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Patient Preferences ◽  
Nyha Class ◽  
General Medicine ◽  
Symptom Burden ◽  
Care Hospital ◽  
Structured Interviews ◽  
The Usa ◽  
Seriously Ill Patients

Background: More than 5 million people in the USA suffer from heart failure (HF). Palliative care (PC) is both a clinical subspecialty and overall approach to care that focuses on promoting seriously ill patients and their family’s quality of life. PC takes several forms, including consultation by a PC specialist, or attention to palliative domains by a non-PC specialist (aka “primary” PC). Despite guidelines calling for the integration of PC in HF, specialty PC remains underutilized. Patient preferences regarding primary vs specialty PC are unknown. Objective: To identify patient knowledge and perceptions regarding how primary and specialty PC could complement usual HF management, as well as barriers preventing PC utilization. Methods: We recruited individuals with NYHA class II-IV HF from general medicine wards and an outpatient advanced HF clinic, both at an academic quaternary care hospital. We conducted semi-structured interviews addressing: (1) patient-perceived physical, emotional, social, and decision-making needs; (2) perception, knowledge, and preferences regarding PC; (3) barriers and facilitators to PC. To understand patient preferences regarding primary vs specialty PC, in the interview guide, we conceptualized PC into 5 domains: physical, emotional, spiritual and social aspects of care, and advance care planning. For each domain, participants discussed unmet needs, and preferences about whether the needs would be best met by their existing cardiology team or a PC specialist. Two investigators independently analyzed data using template analysis, an inductive/deductive qualitative technique. Results: We interviewed 28 patients; 82% were white, 61% were >60 years, and 64% were male. 43% of participants had ejection fractions <30%, and 64% were of NYHA classes III or IV. Symptom burden was high and a source of dissatisfaction; yet, few believed that their disease management was suboptimal, often citing a sense of resignation that symptoms are inevitable in HF. We heard mixed and often incorrect understandings of PC (and its distinction from hospice). Once misperceptions of PC were corrected, respondents expressed variable preferences for specialty vs. primary PC. Proponents of primary PC cited trust and rapport in their existing clinicians, HF-specific expertise, convenience, and cost. Alternatively, participants preferring specialty PC involvement cited expertise in symptom management, addressing caregiver concerns, reduced time constraints, and a comprehensive non-HF-exclusive approach to care. Conclusion: We frequently identified limited and often incorrect understanding of PC. Though once corrected, patients articulated variable preferences for primary vs. specialty PC integration into their existing HF care. Research is needed to identify means of increasing primary and specialty PC delivery in HF in a manner that reflects patient preferences.

Audit of Nausea and Vomiting Management in Palliative Care Hospital Patients

2007 ◽  
Vol 37 (4) ◽  
pp. 306-309 ◽  
Author(s):  
Christel L Burgess ◽  
Penelope HR Tuffin ◽  
Rhonda M Clifford
Keyword(s):  
Palliative Care ◽  
Nausea And Vomiting ◽  
Care Hospital ◽  
Hospital Patients

scholarly journals Added Value of Early Consultation of an Inpatient Palliative Care Team in Hospitalized Older Patients With High Symptom Burden: A Prospective Comparative Study

2020 ◽  
pp. 104990912098260
Author(s):  
Myrthe W. Naaktgeboren ◽  
Fabienne J. H. Magdelijns ◽  
Daisy J. A. Janssen ◽  
Marieke H. J. van den Beuken-van Everdingen
Keyword(s):  
Palliative Care ◽  
Older Patients ◽  
Symptom Burden ◽  
Palliative Care Team ◽  
Care Team ◽  
Added Value ◽  
Symptom Improvement ◽  
Period 2 ◽  
The Impact

Background: It is estimated that in 2050 one quarter of the population in Europe will be aged 65 years and older. Although the added value of a palliative care team is emphasized in the literature, the impact of the palliative care team on the symptom burden in older non-cancer patients is not yet well established. Objectives: To structurally measure symptoms and to investigate whether proactive consultation with a palliative care team results in improvement of symptoms. Design: This study has a prospective comparative design. Setting/Participants: Older patients, admitted to a Dutch University Medical Centre for who a health care professional had a negative response to the Surprise Question, were selected. Measurements, Results: In period one, 59 patients completed the Utrecht Symptom Diary (USD) at day one of admission and after 7 days. In period 2 (n = 60), the same procedure was followed; additionally, the palliative care team was consulted for patients with high USD-scores. Significant improvement on the USD Total Distress Score (TSDS) was observed in both groups without a difference between the 2 periods. This study showed an association between consultation of the palliative care team and improvement on USD TSDS (adjusted odds ratio: 4.9; 95% confidence interval: 1.816-13.198), despite low follow-up rate of advices (approximately 50%). Conclusions: This study emphasizes the importance of creating awareness for consulting the palliative care team. Further research should focus on assessing the reason behind the low follow-up rate of the advice given and understanding the specific advices contributing to symptom improvement.

Perceptions of palliative care: Cancer and non-cancer.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 148-148
Author(s):  
Ingrid Harle ◽  
Christine Knott
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Palliative Medicine ◽  
Clinical Pathways ◽  
Metastatic Cancer ◽  
Symptom Burden ◽  
Cost Savings ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Early Integration

148 Background: Palliative Medicine consultation is greater for cancer than non-cancer patients. Decreased symptom burden, improved survival time and quality of life, and cost savings are associated with palliative care. Most patients do not receive information about palliative care until end of life, resulting in negative outcomes. We examined perceptions and access to Palliative Medicine for persons living with advanced illnesses. The purpose was to inform the design of palliative care pathways for cancer and non-cancer diagnoses. Methods: Using Interpretive Phenomenological Analysis, patients/caregivers with metastatic cancer, chronic kidney disease, chronic obstructive pulmonary disease and advanced heart failure were interviewed. This qualitative research method explores an individual’s lived illness experience. Interviews addressed care processes, teams, understanding of palliative care and goals of care. Six reviewers read, coded, categorized interview transcripts and extracted themes. Results: Fifty interviews were completed, 36/50 with metastatic cancer or COPD. Despite different diagnoses, themes were similar. Caregiver’s responses reflected the patient’s burden and overall experience. Themes were: focused individual care; multiple dimensions of time; 24/7 home care; physical and psychological impacts; and spirituality. Perceptions about Palliative Medicine remain aligned with end of life. Conclusions: Palliative Medicine remains associated with end of life, regardless of the diagnosis. Majority had limited access to palliative care, despite pursuing information on supportive services. They also expressed high expectations of receiving such information from physicians and other providers. Results are similar to national strategies on palliative care. The project’s findings have informed the design of clinical pathways for early integration of Palliative Medicine for patients with cancer and non-cancer diagnoses.

scholarly journals Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan

2010 ◽  
Vol 9 (1) ◽  
Author(s):  
Nanako Tamiya ◽  
Mikako Okuno ◽  
Masayo Kashiwakgi ◽  
Mariko Nishikitani ◽  
Etsuko Aruga
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Palliative Care Team ◽  
Care Team ◽  
Care Hospital

Palliative Care for Inmates in the Hospital Setting

2018 ◽  
Vol 36 (4) ◽  
pp. 321-325 ◽  
Author(s):  
Stephanie L. Stephens ◽  
J. Brian Cassel ◽  
Danielle Noreika ◽  
Egidio Del Fabbro
Keyword(s):  
Palliative Care ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Palliative Care Team ◽  
Care Team ◽  
Care Hospital ◽  
Palliative Care Consultation ◽  
Large Tertiary Care ◽  
Care Consultation

The US population of inmates continues to increase along with a rapid escalation in the number of elderly prisoners. Previous studies have demonstrated multiple barriers to providing palliative care for seriously ill inmates. The aim of this study was to assess the frequency of palliative care consultation and nature of consultation requests for inmates who died while hospitalized at a large tertiary care hospital. A retrospective chart review of all inmate decedents over a 10-year time period was conducted. The reason and timing of consultation was noted in addition to symptoms identified and interventions recommended by the palliative care team. Characteristics of patients who were transferred to the inpatient palliative care unit were also recorded. Forty-five percent of inmates were seen by palliative care prior to their death. Timing of consultation was close to the day of death. Inmates with cancer were significantly more likely to have a palliative care consultation prior to death. The most frequent intervention recommended was opiates for pain or dyspnea. Delirium was often missed by the primary team but was identified by the palliative care team. Nearly, 5000 prisoners die each year, mostly in community hospitals. These patients exhibit similar symptoms to free-living patients. Given that the inmate population has a higher rate of comorbid conditions, there is a need for more research to identify areas of need for incarcerated patients and where palliative care can best serve these individuals.

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