Hospital-Based Palliative Care with Medicare Claims: Evidence From Colorado

2017 ◽  
Vol 35 (1) ◽  
pp. 66-68 ◽  
Author(s):  
Cordt T. Kassner ◽  
Nrupen A. Bhavsar ◽  
Matthew Harker ◽  
Janet Bull ◽  
Donald H. Taylor
Keyword(s):  
Palliative Care ◽  
Medicare Claims ◽  
Care Services ◽  
Medicare Data ◽  
Phone Survey ◽  
Number Of Patients ◽  
Palliative Care Teams ◽  
Palliative Care Services ◽  
Study Setting ◽  
Medicare Claims Data

Background: The prevalence of hospital-based palliative care has been largely anecdotal as an increasing service being provided and there is a need to understand what trends can be analyzed with Medicare data. Objective: To compare 2 methods of identifying hospital-based palliative care in the Medicare population in Colorado. Study Design: Through Medicare claims data and phone surveys, we ascertained the presence of hospital-based palliative care services, number of patients receiving palliative care, and number of care visits provided during the previous year. Data Sources/Study Setting: Data were collected from every Medicare-certified hospital in Colorado during 2008 and 2013. Measurements: We measured the presence of hospital-based palliative care teams and their average number of consultations through a phone survey and cross-referenced using a v-code modifier of Medicare claims indicating a palliative care consult visit. Results: The number of hospital-based palliative care consultations increased five-fold from 2008-2013, and Medicare claims under-counted the number of these consultations compared to phone surveys. Conclusion: The systematic measurement of palliative care nationally is a key priority. More evidence is needed from other states to better understand the usefulness of Medicare claims in this effort.

Early referral to palliative care: Where are we in Brazil?

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24118-e24118
Author(s):  
Andre Filipe Junqueira Santos ◽  
Aurélio Monteiro ◽  
Carolina Sarmento Duarte ◽  
Carolina Gomes Jacobina Silva ◽  
Sarah Ananda Gomes ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Patient Centered ◽  
Early Referral ◽  
Care Services ◽  
Adequate Knowledge ◽  
Number Of Patients ◽  
Palliative Care Teams ◽  
Palliative Care Services

e24118 Background: The American Society of Clinical Oncology (ASCO) recommends that patients with advanced cancer receive dedicated palliative care services concurrently with active treatment within 8 weeks of diagnosis and maintaining follow up for at least 12 weeks. The adherence to these standards in Brazil is unknown. Objective: To evaluate adherence to ASCO recommendations of early referral to a palliative care team at a multicentric outpatient oncological clinic in Brazil using the following indicators: (i) whether patients were enrolled in palliative care services within 8 weeks of diagnosis and (ii) whether patients were followed up for a minimum of 12 weeks. Methods: All palliative care physicians within a network of 15 outpatient oncology clinics (Oncoclinicas Group) prospectively recorded time to care post-diagnosis with advanced cancer by ASCO guidelines and duration of follow up time throughout the 1-year duration of the study. The number of patients enrolled in care within 8 weeks of diagnosis and followed for at least 12 weeks was recorded. An initial goal of adherence was set at 50% for each indicator. Results: Of 1016 patients, we studied 579 data numbers. 26% of patients were referred within 8 weeks of their advanced cancer diagnosis and 23% were followed for 12 weeks or more. Conclusions: These data indicate that even with a recognition of ASCO recommendations for timely palliative care referral, patients in Brazil are often seeing palliative care teams too late. The possible main causes of this late referral in Brazil are: (i) lack of adequate knowledge about the real meaning of palliative care and (ii) a lack of understanding of how a multidisciplinary team acts positively in the patient's experience. We believe that the best way to change this reality is through continuing education about Palliative Care, reinforcing the intention of continuous care: strengthening bonds, facilitating communication, reaching better symptoms control and practicing patient-centered care.

scholarly journals ‘Necessity is the mother of invention’: Specialist palliative care service innovation and practice change in response to COVID-19. Results from a multi-national survey (CovPall)

2020 ◽  
Author(s):  
Lesley Dunleavy ◽  
Nancy Preston ◽  
Sabrina Bajwah ◽  
Andy Bradshaw ◽  
Rachel Cripps ◽  
...  
Keyword(s):  
Palliative Care ◽  
Resource Use ◽  
System Response ◽  
List Type ◽  
Specialist Palliative Care ◽  
It Infrastructure ◽  
Care Services ◽  
Palliative Care Teams ◽  
Palliative Care Services ◽  
Palliative Care Units

AbstractBackgroundSpecialist palliative care services have a key role in a whole system response to COVID-19. There is a need to understand service response to share good practice and prepare for future care.AimTo map and understand specialist palliative care services innovations and practice changes in response to COVID-19 (CovPall).DesignOnline survey of specialist palliative care providers, disseminated via key stakeholders. Data collected on service characteristics, innovations and changes in response to COVID-19. Statistical analysis included frequencies, proportions and means, and free-text comments were analysed using a qualitative framework approach.Setting/participantsInpatient palliative care units, home nursing services, hospital and home palliative care teams from any country.Results458 respondents: 277 UK, 85 Europe (except UK), 95 World (except UK and Europe), 1 missing country. 54.8% provided care across 2+ settings; 47.4% hospital palliative care teams, 57% in-patient palliative care units, and 57% home palliative care teams. The crisis context meant services implemented rapid changes. Changes involved streamlining, extending and increasing outreach of services, using technology to facilitate communication, and implementing staff wellbeing innovations. Barriers included; fear and anxiety, duplication of effort, information overload, funding, and IT infrastructure issues. Enablers included; collaborative teamwork, pooling of staffing resources, staff flexibility, a pre-existing IT infrastructure and strong leadership.ConclusionsSpecialist palliative care services have been flexible, highly adaptive and have adopted a ‘frugal innovation’ model in response to COVID-19. In addition to financial support, greater collaboration is essential to minimise duplication of effort and optimise resource use.ISRCTN16561225https://doi.org/10.1186/ISRCTN16561225Key StatementsWhat is already known about the topic?Specialist palliative care is part of a whole healthcare system response to COVID-19.Services need to make practice changes in response to the global pandemic.What this paper addsSpecialist palliative care services responded rapidly to COVID-19 in both planning for change and then adapting to needs and requirements.Services often relied on ‘improvisation’, ‘quick fixes’ and ‘making do’ when responding to the COVID-19 crisis.Implications for practice, theory or policyIn addition to financial support, greater collaboration is essential to build organisational resilience and drive forward innovation, by minimising duplication of effort and optimising resource use.The effectiveness and sustainability of any changes made during the crisis needs further evaluation.

scholarly journals Where there is no morphine: The challenge and hope of palliative care delivery in Tanzania

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Kristopher Hartwig ◽  
Mervyn Dean ◽  
Kari Hartwig ◽  
Paul Z. Mmbando ◽  
Abduraoof Sayed ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Mixed Method ◽  
Care Delivery ◽  
Oral Morphine ◽  
Psychological Burden ◽  
Care Experience ◽  
Care Services ◽  
Palliative Care Teams ◽  
Palliative Care Services

Background: In Tanzania, a country of 42 million, access to oral morphine is rare.Aim: To demonstrate the effectiveness of palliative care teams in reducing patients’ pain and in increasing other positive life qualities in the absence of morphine; and to document the psychological burden experienced by their clinical providers, trained in morphine delivery, as they observed their patients suffering and in extreme pain.Setting: One hundred and forty-fie cancer patients were included from 13 rural hospitals spread across Tanzania.Method: A mixed method study beginning with a retrospective quantitative analysis of cancer patients who were administered the APCA African POS tool four times. Bivariate analyses of the scores at time one and four were compared across the domains. The qualitative arm included an analysis of interviews with six nurses, each with more than fie years’ palliative care experience and no access to strong opioids.Results: Patients and their family caregivers identifid statistically signifiant (p < 0.001) improvements in all of the domains. Thematic analysis of nurse interviews described the patient and family benefis from palliative care but also their great distress when ‘bad cases’ arose who would likely benefi only from oral morphine.Conclusion: People living with chronic cancer-related pain who receive palliative care experience profound physical, spiritual and emotional benefis even without oral morphine. These results demonstrate the need for continued advocacy to increase the availability of oral morphine in these settings in addition to palliative care services.

scholarly journals Integrating palliative care into neurology services: what do the professionals say?

2017 ◽  
Vol 8 (1) ◽  
pp. 41-44 ◽  
Author(s):  
Nilay Hepgul ◽  
Wei Gao ◽  
Catherine J Evans ◽  
Diana Jackson ◽  
Liesbeth M van Vliet ◽  
...  
Keyword(s):  
Palliative Care ◽  
Online Survey ◽  
Professional Groups ◽  
Care Services ◽  
Palliative Care Teams ◽  
Registration Number ◽  
Palliative Care Services ◽  
Survey Results ◽  
Neurological Conditions ◽  
Online Forms

ObjectivesEvaluations of new services for palliative care in non-cancer conditions are few. OPTCARE Neuro is a multicentre trial evaluating the effectiveness of short-term integrated palliative care (SIPC) for progressive long-term neurological conditions. Here, we present survey results describing the current levels of collaboration between neurology and palliative care services and exploring the views of professionals towards the new SIPC service.MethodsNeurology and palliative care teams from six UK trial sites (London, Nottingham, Liverpool, Cardiff, Brighton and Chertsey) were approached via email to complete an online survey. The survey was launched in July 2015 and consisted of multiple choice or open comment questions with responses collected using online forms.Results33 neurology and 26 palliative care professionals responded. Collaborations between the two specialties were reported as being ‘good/excellent’ by 36% of neurology and by 58% of palliative care professionals. However, nearly half (45%) of neurology compared with only 12% of palliative care professionals rated current levels as being ‘poor/none’. Both professional groups felt that the new SIPC service would influence future collaborations for the better. However, they identified a number of barriers for the new SIPC service such as resources and clinician awareness.ConclusionsOur results demonstrate the opportunity to increase collaboration between neurology and palliative care services for people with progressive neurological conditions, and the acceptability of SIPC as a model to support this.Trial registration numberISRCTN18337380; Pre-results.

scholarly journals ‘Necessity is the mother of invention’: Specialist palliative care service innovation and practice change in response to COVID-19. Results from a multinational survey (CovPall)

2021 ◽  
pp. 026921632110006
Author(s):  
Lesley Dunleavy ◽  
Nancy Preston ◽  
Sabrina Bajwah ◽  
Andy Bradshaw ◽  
Rachel Cripps ◽  
...  
Keyword(s):  
Palliative Care ◽  
Good Practice ◽  
System Response ◽  
Free Text ◽  
Care Providers ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Teams ◽  
Palliative Care Services ◽  
Palliative Care Units

Background: Specialist palliative care services have a key role in a whole system response to COVID-19, a disease caused by the SARS-CoV-2 virus. There is a need to understand service response to share good practice and prepare for future care. Aim: To map and understand specialist palliative care services innovations and practice changes in response to COVID-19. Design: Online survey of specialist palliative care providers (CovPall), disseminated via key stakeholders. Data collected on service characteristics, innovations and changes in response to COVID-19. Statistical analysis included frequencies, proportions and means, and free-text comments were analysed using a qualitative framework approach. Setting/participants: Inpatient palliative care units, home nursing services, hospital and home palliative care teams from any country. Results: Four hundred and fifty-eight respondents: 277 UK, 85 Europe (except UK), 95 World (except UK and Europe), 1 missing country. 54.8% provided care across 2+ settings; 47.4% hospital palliative care teams, 57% in-patient palliative care units and 57% home palliative care teams. The crisis context meant services implemented rapid changes. Changes involved streamlining, extending and increasing outreach of services, using technology to facilitate communication, and implementing staff wellbeing innovations. Barriers included; fear and anxiety, duplication of effort, information overload and funding. Enablers included; collaborative teamwork, staff flexibility, a pre-existing IT infrastructure and strong leadership. Conclusions: Specialist palliative care services have been flexible, highly adaptive and have adopted low-cost solutions, also called ‘frugal innovations’, in response to COVID-19. In addition to financial support, greater collaboration is essential to minimise duplication of effort and optimise resource use. ISRCTN16561225 https://doi.org/10.1186/ISRCTN16561225

scholarly journals Interstitial lung disease and specialist palliative care access: a healthcare professionals survey

2020 ◽  
pp. bmjspcare-2019-002148
Author(s):  
Jee Whang Kim ◽  
Sandra Olive ◽  
Steve Jones ◽  
Muhunthan Thillai ◽  
Anne-Marie Russell ◽  
...  
Keyword(s):  
Palliative Care ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Healthcare Professionals ◽  
Symptom Control ◽  
Survey Study ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Teams ◽  
Palliative Care Services

BackgroundFibrotic interstitial lung disease is an incurable disease with poor prognosis. We aimed to understand factors affecting decisions regarding referrals to specialist palliative care services and to address barriers and facilitators to referrals from healthcare professionals’ perspectives.MethodsA survey study of healthcare professionals, including respiratory physicians, interstitial lung disease nurse specialists, respiratory nurse specialists and palliative care physicians, was conducted using a questionnaire, entailing 17 questions.ResultsThirty-six respondents, including 15 interstitial lung disease nurse specialists completed the questionnaire. Symptom control, psychological/spiritual support, general deterioration and end-of-life care were the most common reasons for referrals to specialist palliative care services. Most respondents felt confident in addressing palliative care needs and discussing palliative care with patients. A few participants emphasised that experienced respiratory nurse specialists are well placed to provide symptom management and to ensure continuity of patient care. Participants reported that access to palliative care could be improved by increasing collaborative work between respiratory and palliative care teams.ConclusionsMost respondents felt that enhancing access to specialist palliative care services would benefit patients. However, palliative care and respiratory care should not be considered as mutually exclusive and multidisciplinary approach is recommended.

Perceptions of the care received from Australian palliative care services: A caregiver perspective

2017 ◽  
Vol 16 (2) ◽  
pp. 198-208 ◽  
Author(s):  
Tanya M. Pidgeon ◽  
Claire E. Johnson ◽  
Leanne Lester ◽  
David Currow ◽  
Patsy Yates ◽  
...  
Keyword(s):  
Palliative Care ◽  
Information Needs ◽  
Physical Symptoms ◽  
Community Services ◽  
Inpatient Setting ◽  
Practical Training ◽  
Caregiver Support ◽  
Care Services ◽  
Palliative Care Teams ◽  
Palliative Care Services

ABSTRACTBackground:Caregiver satisfaction and experience surveys help health professionals to understand, measure, and improve the quality of care provided for patients and their families.Objective:Our aim was to explore caregiver perceptions of the care received from Australian specialist palliative care services.Method:Caregivers of patients receiving palliative care in services registered with Australia's Palliative Care Outcomes Collaboration were invited to participate in a caregiver survey. The survey included the FAMCARE–2 and four items from the Ongoing Needs Identification: Caregiver Profile questionnaire.Results:Surveys were completed by 1,592 caregivers from 49 services. Most respondents reported high satisfaction and positive experiences. Caregivers receiving care from community-based palliative care teams were less satisfied with the management of physical symptoms and comfort (odds ratio [OR] = 0.29; 95% confidence interval [CI95%] = 0.14, 0.59), with patient psychological care (OR = 0.56; CI95% = 0.32, 0.98), and with family support (OR = 0.52; CI95% = 0.35, 0.77) than caregivers of patients in an inpatient setting. If aged over 60 years, caregivers were less likely to have their information needs met regarding available support services (OR = 0.98; CI95% = 0.97, 0.98) and carer payments (OR = 0.99; CI95% = 0.98, 1.00). Also, caregivers were less likely to receive adequate information about carer payments if located in an outer regional area (OR = 0.41; CI95% = 0.25, 0.64). With practical training, caregivers receiving care from community services reported inadequate information provision to support them in caring for patients (OR = 0.60; CI95% = 0.45, 0.81).Significance of Results:While our study identified caregivers as having positive and satisfactory experiences across all domains of care, there is room for improvement in the delivery of palliative care across symptom management, as well as patient and caregiver support, especially in community settings. Caregiver surveys can facilitate the identification and evaluation of both patients' and caregivers' experiences, satisfaction, distress, and unmet needs.

Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update

2017 ◽  
Vol 35 (1) ◽  
pp. 96-112 ◽  
Author(s):  
Betty R. Ferrell ◽  
Jennifer S. Temel ◽  
Sarah Temin ◽  
Erin R. Alesi ◽  
Tracy A. Balboni ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Oncology ◽  
Advanced Cancer ◽  
Expert Panel ◽  
Care Services ◽  
Palliative Care Teams ◽  
Palliative Care Services ◽  
Secondary Analyses ◽  
Oncology Care ◽  
American Society

Purpose To provide evidence-based recommendations to oncology clinicians, patients, family and friend caregivers, and palliative care specialists to update the 2012 American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) on the integration of palliative care into standard oncology care for all patients diagnosed with cancer. Methods ASCO convened an Expert Panel of members of the ASCO Ad Hoc Palliative Care Expert Panel to develop an update. The 2012 PCO was based on a review of a randomized controlled trial (RCT) by the National Cancer Institute Physicians Data Query and additional trials. The panel conducted an updated systematic review seeking randomized clinical trials, systematic reviews, and meta-analyses, as well as secondary analyses of RCTs in the 2012 PCO, published from March 2010 to January 2016. Results The guideline update reflects changes in evidence since the previous guideline. Nine RCTs, one quasiexperimental trial, and five secondary analyses from RCTs in the 2012 PCO on providing palliative care services to patients with cancer and/or their caregivers, including family caregivers, were found to inform the update. Recommendations Inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment. Referral of patients to interdisciplinary palliative care teams is optimal, and services may complement existing programs. Providers may refer family and friend caregivers of patients with early or advanced cancer to palliative care services.

Dying with dignity: the challenges of end-of-life care in patients with substance use disorders

2021 ◽  
Vol 14 (11) ◽  
pp. e240945
Author(s):  
Prasun Datta ◽  
Jeffrey S Kruk ◽  
Kylie Jordan ◽  
Karen A Fisher
Keyword(s):  
Palliative Care ◽  
Substance Use ◽  
End Of Life ◽  
Addiction Medicine ◽  
Opioid Agonist ◽  
Care Services ◽  
Dying With Dignity ◽  
Palliative Care Teams ◽  
Palliative Care Services ◽  
History Of

Substance use disorder is a chronic disease carrying a high risk of morbidity and mortality. We report a case of a patient on long-term opioid agonist treatment who was diagnosed with metastatic cholangiocarcinoma and was referred to palliative care services almost contemporaneously with this diagnosis. In this report, we explore the challenges posed in offering holistic care during the end of life of a patient with a history of opioid dependence. A coordinated approach by addiction medicine and palliative care teams can allow patients from this complex cohort to ultimately die with dignity.

The availability of and satisfaction with palliative care services among VHA-based radiation oncologists.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 55-55
Author(s):  
George A. Dawson ◽  
Alice V. Cheuk ◽  
Shruti Jolly ◽  
Ruchika Gutt ◽  
Drew Moghanaki ◽  
...  
Keyword(s):  
Palliative Care ◽  
Radiation Oncology ◽  
Psychosocial Support ◽  
Care Delivery ◽  
Symptom Control ◽  
Care Services ◽  
Radiation Oncologists ◽  
Advanced Malignancies ◽  
Palliative Care Teams ◽  
Palliative Care Services

55 Background: Palliative care services enhance quality of life in patients with advanced malignancies and are an integral component of multidisciplinary cancer care. They provide symptom control and psychosocial support for patients and family members. A survey in non-VHA cancer centers showed that despite availability of palliative care programs, there was wide variability in the use of these services (Hui et al, JAMA 2010). Palliative care services are a component of the VHA medical benefits package. We sought to determine the ease of access to palliative care services and provider satisfaction among VHA Radiation Oncologists. Methods: VHA-based Radiation Oncologists were identified using the National VHA Radiation Oncology list serve group. All practicing Radiation Oncologists were surveyed to determine the extent of Palliative Care Services available to them and to measure their level of satisfaction with these services. Eighty two surveys were electronically mailed to practitioners at the 38 active VHA Radiation Oncology sites, followed by a reminder phone call.This survey was conducted over a four week period in May of 2014. Results: Sixty four of the 82 surveys distributed over the 4 week period, or 78% were completed. They represent 89% (34/38) of VHA Radiation Oncology Services. All respondents had Palliative Care Services available to them and 98% were happy with the services rendered by the Palliative Care teams. Conclusions: All VHA-based Radiation Oncologists who responded to this survey have access to local VHA based Palliative Care Services. This represented 82% of VHA Radiation Oncology practitioners and 98% were satisfied with the services rendered. Further studies should explore the scope and extent of palliative care involvement including when these services are integrated into the management of patients with advanced malignancies, availability of outpatient palliative care services and variations in care delivery. Radiation therapy is utilized in over 50% of patients with malignancy, often in advanced disease for symptom management and standard guidelines integrating radiotherapy and palliative care should be developed.

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