A quasi-experimental controlled evaluation of the impact of a hospice rapid response community service for end-of-life care on achievement of preferred place of death

Objective To evaluate the impact of a multifaceted strategy for quality end-of-life care in a tertiary public hospital in Brazil. Methodology The study design was quasi-experimental. The multifaceted strategy was applied between January and June 2017, and involved training the healthcare team in end-of-life discussions, the creation and documentation of advance directives, and consultation with the team specialized in palliative care. The periods analyzed were the pre-test period (Time 1, July 2015 to June 2016) and the post-test period (Time 2, July 2017 to June 2018). Results Time 1 involved 302 deaths, with an average hospital stay of 21 days; Time 2 involved 410 deaths, with an average hospital stay of 16 days. Patients were prescribed morphine (44.04% vs. 36.3% [ p = 0.367]), methadone (9.60% vs. 4.39% [ p = 0.247]), midazolam (43.05% vs. 47.80% [ p = 0.73]), blood transfusions (31.13% vs. 24.63% [ p = 0.828]), enteral feeding (56.62% vs. 38.54% [ p = 0.59]) and antibiotic therapy (50.73% vs. 50.73% [ p = 0.435]). Conclusion This study found no changes in the end-of-life care quality indicators after the strategy was implemented. Multimodal educational strategies that develop communication skills in palliative care may enhance the quality of end-of-life care.

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Effectiveness of Pediatric Concurrent Hospice Care to Improve Continuity of Care

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211056039 ◽

2021 ◽

pp. 104990912110560

Author(s):

Lisa C. Lindley ◽

Melanie J. Cozad ◽

Jennifer W. Mack ◽

Jessica Keim-Malpass ◽

Radion Svynarenko ◽

...

Keyword(s):

Emergency Room ◽

End Of Life ◽

End Of Life Care ◽

Hospice Care ◽

Policy Implications ◽

Life Care ◽

Instrumental Variable Analysis ◽

Care Continuity ◽

Quasi Experimental ◽

The Impact

Background The 2010 Patient Protection and Affordable Care Act (ACA) mandated landmark hospice care legislation for children at end of life. Little is known about the impact of pediatric concurrent hospice care. Objective The purpose of this study was to examine the effect of pediatric concurrent vs standard hospice care on end-of-life care continuity among Medicaid beneficiaries. Methods Using national Medicaid data, we conducted a quasi-experimental designed study to estimate the effect of concurrent vs standard hospice care to improve end-of-life care continuity for children. Care continuity (i.e., hospice length of stay, hospice disenrollment, emergency room transition, and inpatient transition) was measured via claims data. Exposures were concurrent hospice vs standard hospice care. Using instrumental variable analysis, the effectiveness of exposures on care continuity was compared. Results Concurrent hospice care affected care continuity. It resulted in longer lengths of stays in hospice ( β = 2.76, P < .001) and reduced hospice live discharges ( β = −2.80, P < .05), compared to standard hospice care. Concurrent care was not effective at reducing emergency room ( β = 2.09, P < .001) or inpatient care ( β = .007, P < .05) transitions during hospice enrollment. Conclusion Our study provides critical insight into the quality of care delivered for children at end of life. These findings have policy implications.

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What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death

Palliative Medicine ◽

10.1177/0269216317734435 ◽

2017 ◽

Vol 32 (2) ◽

pp. 329-336 ◽

Cited By ~ 90

Author(s):

Anna E Bone ◽

Barbara Gomes ◽

Simon N Etkind ◽

Julia Verne ◽

Fliss EM Murtagh ◽

...

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Population Based ◽

Population Ageing ◽

Place Of Death ◽

Life Care ◽

The Future ◽

The Impact

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The Impact of Population Ageing on End-of-Life Care in Scotland: Population-based Projections of Place of Death and Recommendations for Future Service Provision

10.26226/morressier.5c76c8b6e2ea5a723761225c ◽

2019 ◽

Author(s):

Anne Finucane

Keyword(s):

End Of Life ◽

Service Provision ◽

End Of Life Care ◽

Population Based ◽

Population Ageing ◽

Place Of Death ◽

Life Care ◽

The Impact

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A Population-Based Conceptual Framework for Evaluating the Role of Healthcare Services in Place of Death

Healthcare ◽

10.3390/healthcare6030107 ◽

2018 ◽

Vol 6 (3) ◽

pp. 107 ◽

Cited By ~ 4

Author(s):

Wei Gao ◽

Sumaya Huque ◽

Myfanwy Morgan ◽

Irene Higginson

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Healthcare Service ◽

Healthcare Services ◽

Population Based ◽

Place Of Death ◽

Life Care ◽

The Impact ◽

Service Factors

Background: There is a significant geographical disparity in place of death. Socio-demographic and disease-related variables only explain less than a quarter of the variation. Healthcare service factors may account for some (or much) of the remaining variation but their effects have never been systematically evaluated, partly due to the lack of a conceptual framework. This study aims to propose a population-based framework to guide the evaluation of the role of the healthcare service factors in place of death. Methods: Review and synthesis of health service models that include the impact of a service component on either place of death/end of life care outcomes or service access/utilization. Results: The framework conceptualizes the impact of healthcare services on the place of death as starting from the end of life care policies that in turn influence service commissioning and shape healthcare service characteristics, including service type, service capacity—facilities, service location, and workforce, through which service utilization and ultimately place of death are affected. Patient socio-demographics, disease-related variables, family and community support and social care also influence place of death, but they are not the focus of this framework and therefore are grouped as needs and other environmental factors. Information on service utilization, together with the place of death, creates loop feedback to inform policy and service commission. Conclusions: The framework provides guidance for analysis aiming to understand the role of healthcare services in place of death. It aids the interpretation of results in the light of existing knowledge and potentially identifies service factors that can be addressed to improve end of life care.

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The Impact of Nursing Homes Staff Education on End-of-Life Care in Residents With Advanced Dementia: A Quality Improvement Study

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2018.10.268 ◽

2019 ◽

Vol 57 (1) ◽

pp. 93-99 ◽

Cited By ~ 6

Author(s):

Paola Di Giulio ◽

Silvia Finetti ◽

Fabrizio Giunco ◽

Ines Basso ◽

Debora Rosa ◽

...

Keyword(s):

Quality Improvement ◽

Nursing Homes ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Advanced Dementia ◽

Staff Education ◽

The Impact

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Nursing care at end of life: a UK-based survey of the deaths of people living in care settings for people with intellectual disability

Journal of Research in Nursing ◽

10.1177/1744987118780919 ◽

2018 ◽

Vol 24 (6) ◽

pp. 366-382 ◽

Cited By ~ 5

Author(s):

Ruth Northway ◽

Stuart Todd ◽

Katherine Hunt ◽

Paula Hopes ◽

Rachel Morgan ◽

...

Keyword(s):

Intellectual Disability ◽

End Of Life ◽

Nursing Care ◽

End Of Life Care ◽

Life Care ◽

Care Providers ◽

Nursing Support ◽

Respiratory Problems ◽

The Uk ◽

The Impact

Background People with intellectual disability are believed to be at risk of receiving poor end-of-life care. Nurses, given their advocacy role and duty to provide compassionate end-of-life care, have the potential to change this situation but research regarding this aspect of their role is limited. Aims This paper thus seeks to answer the question ‘How and when are nurses involved in providing care at end of life for people with intellectual disability?’ Methods A total of 38 intellectual disability care providers in the UK providing support to 13,568 people with intellectual disability were surveyed. Data regarding 247 deaths within this population were gathered in two stages and subsequently entered into SPSSX for analysis. Results Findings revealed that the majority of deaths occurred between the ages of 50 and 69 years, the most commonly reported cause of death being respiratory problems. Both community and hospital-based nurses were involved in supporting individuals during their final 3 months of life, and sometimes more than one type of nurse provided support to individuals. Generally nursing care was rated positively, although room for improvement was also identified. Conclusions Nurses are involved in supporting people with intellectual disability at end of life and appropriate education is required to undertake this role. This may require change in curricula and subsequent research to determine the impact of such change on nursing support to this population.

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