Abstract WP363: Trends and Disparities in Utilization of Palliative Care for Ischemic Stroke Patients Undergoing Thrombolytic Therapies: 10-Year Analysis of Nationwide Data

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kristie Chu ◽  
Erica Jones ◽  
Arvind B Bambhroliya ◽  
Jennifer R Meeks ◽  
Farhaan Vahidy
Keyword(s):  
Palliative Care ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Long Term Care ◽  
Home Health ◽  
Term Care ◽  
Treatment Type ◽  
Comorbidity Burden ◽  
Iv Tpa

Introduction: We characterize 10-year nationwide trends in utilization of palliative care (PC) for ischemic stroke (IS) patients and describe in-hospital outcomes and costs for IS patients receiving PC, particularly those with acute thrombolytic therapy (TT) i.e. IV tPA and endovascular thrombectomy (EVT). Methods: We analyzed the National Inpatient Sample (90% US hospitalizations) from 2006 - 2015 and identified adult (age ≥18) IS patients, with or without TT and PC using validated ICD-9 codes. We used survey design methods to report nationally representative adjusted odds ratios (aOR) of PC utilization across five 2-year time periods. Results: Of 4,249,201 IS encounters, 4% were coded for PC utilization. PC utilization increased over time (aOR 4.80, 95% CI 4.15 - 5.55), regardless of acute treatment type (Figure 1a). Advanced age, female sex, White race, non-Medicare insurance, higher income, disease severity and comorbidity burden, and discharge from teaching hospitals in non-Northeastern regions were independently associated with receiving PC. In the fully adjusted model, treatment with IV tPA and EVT respectively confer a 5% and 10% greater likelihood of receiving PC. Overall, PC utilization is associated with higher mortality (aOR 15.14, 95% CI 14.36 - 15.96). However, 10-year outcome trends demonstrate a significant decline in in-hospital mortality compared to all other dispositions (aOR 0.46, 95% CI 0.38 - 0.56) with an increasing proportion of PC patients receiving long-term care and home health/hospice (aOR 2.42, 95% CI 2.03 - 2.88) (Figure 1b). Despite longer length of stay, PC hospitalizations incurred 16% lower adjusted costs. Conclusions: Though PC utilization has increased in IS patients, considerable disparities exist. Acute TT is associated with higher PC utilization and outcome trends indicate lower in-hospital mortality with higher long-term care and home health/hospice. Protocolized PC for IS patients may optimize outcomes and costs.

Promoting palliative care access to persons with cancer: A model for mapping statewide services.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 127-127
Author(s):  
Constance Dahlin ◽  
Joshua Nyambose ◽  
Gail Merriam ◽  
Cherline Gene
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Long Term Care ◽  
Home Health ◽  
Term Care ◽  
Care Access ◽  
Care Services ◽  
Health Agencies ◽  
Palliative Care Services

127 Background: The CDC comprehensive cancer initiatives value comprehensive quality care within its mission and program development. Currently, over 75% of hospitals in the United States have palliative care services for cancer patients (CAPC 2011). In order to promote access to quality palliative care in the community outside the hospital, an evaluation is essential. The CDC model of comprehensive cancer care and prevention control structure is an appropriate mechanism to perform such an evaluation. From 2014-2015, the Massachusetts Comprehensive Cancer and Prevention Control Network Palliative Care Workgroup performed a survey to hospitals, home health agencies, hospices, long term care facilities, and community providers to determine palliative care services available to cancer patients across the state. Methods: Using the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines, a robust palliative survey tool was created by the Massachusetts Comprehensive Cancer and Prevention Control Palliative Care Workgroup. It was individualized to each of the following settings - hospitals, home health organizations, hospices, skilled nursing facilities, and community health agencies. Follow-up telephonic key informant interviews regarding palliative care services were conducted within the various settings, service organizations, and insurers. Results: The results of qualitative and quantitative data will be concluded in August. Initial results reveal significant disparities in access to palliative care across by geography and setting of care. Hospices and hospitals had the most access to palliative care services. Long term care settings and community health settings had the least access. Conclusions: Data reveals disparities in palliative care access within Massachusetts by geography, race, and setting of cancer care. This data will serve as the basis of regional networks to promote better access to palliative care for cancer patients across all settings. It is hoped this evaluation process will serve as a model for other states to perform a similar evaluation.

scholarly journals Evaluating the integration of palliative care in national health systems: an indicator rating process with EAPC task force members to measure advanced palliative care development

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Natalia Arias-Casais ◽  
Eduardo Garralda ◽  
Miguel Antonio Sánchez-Cárdenas ◽  
John Y. Rhee ◽  
Carlos Centeno
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Long Term Care ◽  
Task Force ◽  
National Level ◽  
Structured Interviews ◽  
Term Care ◽  
Care Facilities ◽  
Rating Process

Abstract Background Palliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology. Aim To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above. Methods A process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy. Results The literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines. Conclusion Meaningful contributions are being made in Europe towards the integration of PC into the explored fields. These efforts should be assessed in future regional mapping studies using indicators to deliver a more complete picture of PC development.

Combating Coronavirus Disease-2019 Outbreak in Long-Term Care Facilities for Frail Older Adults: Preventive Measures and Palliative Care Go Hand-in-Hand

2021 ◽  
pp. 082585972110393
Author(s):  
Hon Wai Benjamin Cheng
Keyword(s):  
Palliative Care ◽  
Long Term Care ◽  
Care Delivery ◽  
Nursing Home Residents ◽  
Respiratory Illness ◽  
Term Care ◽  
The People ◽  
Care Facilities ◽  
Novel Coronavirus

While the whole population is at risk from infection with the coronavirus, older people—often frail and subject to multimorbidity—are at the highest risk for the severe and fatal disease. Despite strict infection control and social distancing measures, frail adults in long-term care facilities may be at particular risk of transmission of respiratory illness. Treatment decisions are often complex attributed to the heterogeneity of this population with regards to different geriatric domains such as functional status, comorbidity, and poly-pharmacy. While measures must be taken to prevent the novel coronavirus from spreading through these facilities, it is also essential that residents with coronavirus disease 2019 (COVID-19) have access to the symptom management and support they want and deserve. What most nursing home residents want during the course of their illness is to be able to stay in their facilities, to be surrounded by the people they love most, and to feel relief from their physical and emotional pain. By addressing the limited access to hospice and palliative care delivery in nursing homes, we can prevent unnecessary suffering and pain from COVID-19 as well as lay the groundwork for improving care for all residents moving forward.

Palliative care: Long-term solution for long-term care–Part I (CE)

2001 ◽  
Vol 6 (3) ◽  
pp. 90-99
Author(s):  
Mellar P. Davis ◽  
E.Duke Dickerson ◽  
Marco Pappagallo ◽  
James Varga ◽  
John Shuster ◽  
...  
Keyword(s):  
Palliative Care ◽  
Long Term Care ◽  
Term Care

scholarly journals MaineHealth: Development, Implementation, and Success in Telehealth for Home Care

2018 ◽  
Vol 2 (5) ◽  
Author(s):  
Robert Abel
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Long Term Care ◽  
Opinion Leaders ◽  
Term Care ◽  
National Conference ◽  
Chief Nursing Officer ◽  
Care At Home ◽  
Medicine Today

No abstract available. Editor’s note: On March 16th and 17th, 2017, Telehealth and Medicine Today convened a national conference of opinion leaders to discuss and debate “Technologies and Tactics Transforming Long-term Care.” What follows is the lecture by Robert Abel who is the Chief Nursing Officer and Director of Palliative Care for MaineHealth Care at Home, a member of the MaineHealth system.

scholarly journals Quantity over Quality? Perception of Designating Long-Term Care Hospitals as Providers of Hospice and Palliative Care

2019 ◽  
Vol 22 (4) ◽  
pp. 145-155
Author(s):  
Yaeji Kim-Knauss ◽  
Eunseok Jeong ◽  
Jin-ah Sim ◽  
Jihye Lee ◽  
Jiyeon Choo ◽  
...  
Keyword(s):  
Palliative Care ◽  
Long Term Care ◽  
Term Care ◽  
Quality Perception ◽  
Hospice And Palliative Care

scholarly journals Staff Perspectives of Barriers to Access and Delivery of Palliative Care for Persons With Dementia in Long-Term Care

2018 ◽  
Vol 33 (5) ◽  
pp. 284-291 ◽  
Author(s):  
Emily Hill ◽  
Marie Y. Savundranayagam ◽  
Aleksandra Zecevic ◽  
Marita Kloseck
Keyword(s):  
Palliative Care ◽  
Long Term Care ◽  
Care Staff ◽  
Term Care ◽  
Palliative Care Education ◽  
Barriers To Access ◽  
Communication Difficulties ◽  
Phenomenological Methodology

Dementia is a syndrome that is progressive, degenerative, and terminal. The palliative care philosophy aims to maximize quality of life for the dying individual and is both beneficial for and underused with persons dying with dementia. Objectives: The purpose of this study was to investigate the experiences of long-term care staff delivering palliative care to individuals with dementia to determine how care was delivered, to learn which guidelines were used, and whether policies affected the delivery of palliative care. Methods: Twenty-two staff participants were interviewed. Their experiences were interpreted using phenomenological methodology. Results: Findings yielded 3 key themes: confusion, resource shortages, and communication difficulties. Conclusion: Implications for practice include clarification of terminology surrounding palliative care, education of families about dementia and palliative care, better resource management, and the need to address when palliative care best fits within the dementia process.

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