Surgical Versus Medical Team Assignment and Secondary Palliative Care Services for Patients Dying in a Cardiac Hospital

2018 ◽  
Vol 36 (4) ◽  
pp. 316-320
Author(s):  
Benjamin Gandesbery ◽  
Krista Dobbie ◽  
Emer Joyce ◽  
Laura Hoeksema ◽  
Silvia Perez Protto ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Palliative Care ◽  
Hospice Care ◽  
Univariate Analysis ◽  
Medical Team ◽  
Do Not Resuscitate ◽  
Surgical Team ◽  
Multivariable Logistic Regression Model ◽  
Surgical Teams ◽  
Team Assignment

Background: Secondary palliative care (SPC) provides several benefits for patients with cardiovascular disease, but historically, it has been underutilized in this population. Prior research suggests a low rate of SPC consultation by surgical teams in general, but little is known about how surgical teams utilize SPC in the setting of severe cardiovascular disease. Aim: To determine if surgical team assignment affects the probability of SPC for inpatients dying of cardiovascular disease. Design: Retrospective, cohort study. Methods: We identified all inpatients at a large cardiac hospital who had anticipated death under the care of a cardiology, cardiac surgery, or vascular surgery team in 2016. Our primary outcome was referral to SPC, including palliative medicine consultation or inpatient hospice care. Informed by univariate analysis, we created a multivariable logistic regression model, the significance of which was assessed with the Wald test. Results: Two hundred thirty-seven patients were included in our analysis: 93 (39%) received SPC and 144 (61%) were “missed opportunities.” Secondary palliative care was less frequent in patients assigned to a surgical, versus medical, team (11% vs 47%, P < .001). On multivariate analysis, surgical versus medical team assignment was the strongest risk-adjusted predictor of SPC (odds ratio [OR]: 0.10, P < .001). Other predictors of SPC included do not resuscitate status on admission (OR: 14, P < .001), length of stay (OR = 1.05/day, P < .001), and having Medicare (OR = 3.9, P = .002). Conclusions: Primary inpatient care by a surgical team had a strong inverse relationship with SPC. This suggests a possible cultural barrier within surgical disciplines to SPC.

Impact of palliative care referral on hospice enrollment: A single center analysis.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 17-17
Author(s):  
Shreya Sinha ◽  
Alina Basnet ◽  
Wajihuddin Syed ◽  
Pallavi Koparthy ◽  
Rashad Khan ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Hospice Care ◽  
Univariate Analysis ◽  
Insurance Status ◽  
Disease Course ◽  
Advanced Directives ◽  
Early Palliative Care ◽  
Care Services ◽  
Palliative Care Services

17 Background: Despite ASCO’s recommendation to introduce palliative care services for all patients diagnosed with localized or metastatic pancreatic cancer, most patients’ care does not involve this multimodality approach. Transitioning patients to hospice at an appropriate time is essential in oncologic practice. The purpose of this study is to identify which variables affect acceptance of hospice services by patients. Methods: A retrospective chart review of patients with pancreatic cancer treated at Upstate University Hospital from 2011-2015 was performed. We studied variables including age, sex, race, stage, insurance status, advance directives, performance status and laboratory values. We analyzed patients based on acceptance or rejection of hospice care in their disease course and conducted a univariate analysis on different factors to determine predisposing variables. p-values were calculated using Chi-Square test and t-test. Results: We reviewed 325 patients charts and found statistically significant relation to acceptance of hospice and insurance status, and involvement of palliative care in their care. Patients with Medicare were more likely to decline hospice care whereas patients with Medicaid or no insurance were more likely to accept it. 36.23% of patients saw palliative care services at any point in their treatment course and these patients were more likely to accept hospice care than patients who did not (p = < 0.0001). Patients who were seen by palliative care earlier in their disease course were more likely to accept hospice care, although this did not reach statistical significance (p = 0.0731). Patients with stage IV disease were more likely to accept hospice care (p = 0.0095). Other variables like presence of advanced directives, tumor markers, age, and sex did not have a significant impact. Conclusions: Palliative care involvement is beneficial in patients with pancreatic cancer as they face a rough disease course with multiple treatment and disease related morbidities. Patients with early palliative care involvement during their illness are more likely to decide on hospice care at the end stages of their malignancies. This supports early palliative care introduction as an adjunct to oncologic care.

A Month in an Acute Palliative Care Unit

2011 ◽  
Vol 28 (8) ◽  
pp. 550-555 ◽  
Author(s):  
Ahmed Elsayem ◽  
Bianca B. Calderon ◽  
Eden M. Camarines ◽  
Gabriel Lopez ◽  
Eduardo Bruera ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Do Not Resuscitate ◽  
Advanced Cancer Patients ◽  
Financial Outcomes ◽  
Clinical Interventions ◽  
Medical Interventions ◽  
Code Status ◽  
Palliative Care Consultation ◽  
Consultation Team

Background: Few cancer centers have developed acute palliative care units (APCUs). The purpose of this study is to highlight clinical interventions and financial outcomes during a typical 1-month period on an APCU. Methods: We evaluated consecutive patients admitted to our APCU from February 1 to 28, 2009, regarding demographic information, sources of and reasons for admissions, resuscitation status, clinical interventions, disposition, and reimbursement data. Results: Forty-two patients were admitted during a 1-month period. Of these, 30 (71%) were referred from the inpatient palliative care consultation team. In all, 10 (24%) patients had a full code status on admission, and 8 had their status changed to do not resuscitate (DNR) prior to discharge. A total of 11 (26%) patients were discharged home with hospice care, 12 (29%) died on the APCU, and 10 (24%) were discharged home with outpatient follow-up visits. All patients received intravenous medications and the majority received intravenous antibiotics. All patients met acute care criteria for hospitalization, and financial reimbursement was satisfactory and comparable to that of other oncology patients. Conclusion: The APCU model is designed for the care of very complex advanced cancer patients. Palliative interventions are given simultaneously with other medical interventions. The APCU is labor intensive and well reimbursed.

SURGICAL VERSUS MEDICAL TEAM ASSIGNMENT AND SECONDARY PALLIATIVE CARE SERVICES FOR PATIENTS DYING IN A CARDIAC HOSPITAL

2018 ◽  
Vol 71 (11) ◽  
pp. A2634
Author(s):  
Benjamin Gandesbery ◽  
Emer Joyce ◽  
Krista Dobbie ◽  
Laura Hoeksema ◽  
Silvia E. Perez-Protto ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Team ◽  
Care Services ◽  
Palliative Care Services ◽  
Team Assignment

Interdisciplinary palliative care services for cancer patients: Assessing quality of care and outcomes measures of successful intervention.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 127-127
Author(s):  
Yun Rose Li ◽  
Eric Anderson ◽  
Beverly Ingelson ◽  
Kiarash Noorizadeh
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Hospice Care ◽  
Critical Role ◽  
Failure To Thrive ◽  
Primary Diagnosis ◽  
Do Not Resuscitate ◽  
Readmission Rates ◽  
Oncology Patients ◽  
Code Status

127 Background: Interdisciplinary palliative care (IPC) services play a critical role in improving patient care by establishing goals of care and expectations, reducing unnecessary readmissions, and limiting the resource and economic costs associated with end-of-life care. Identifying factors that impact the likelihood of readmissions and measures that help facilitate the transition of patients to hospice care may reduce these costs. Methods: We retrospectively reviewed the demographics, clinical parameters, and outcomes of nearly 500 patient consultations performed by the IPC service at our institution between 2014-2016. Focusing on patients with cancer as the primary diagnosis, we evaluated factors that increased the risk of 6-month readmission, likelihood of transitioning to hospice, and documentation of code-status at time of discharge using Fisher’s exact test and student’s t-tests. Results: Among all patients evaluated by IPC, the median age at consultation was 79.2+/-14.7, and 56.3% are male. Advanced cancer was the most common primary diagnosis (45.5%), with median age 70.9+/-16.0, and 62.1% are male. The 6-month readmission rate among oncology patients (6.5%) was not significantly greater than observed in non-oncology patients (5.9%), P = 0.95, although it was significantly lower than in Medicare patients (~20% in 30 days). Shortness of breath (SOB) was the most common chief complaint (53.9%) on admission. Compared to other chief complaints, such as failure to thrive and frailty, SOB was not associated with increased readmission rates. Reduced readmission rates were strongly reduced with transition to hospice (p < 2.1x10-4) and Do-Not-Resuscitate code status (p < 0.04). Disposition to home at discharge (p < 8.01e-05) was significantly associated with 6-month readmission, as compared to discharge to hospice (0.8%) or SNF (15.0%). Female patients (9/74) were more likely to be readmitted as compared to males (4/132), p < 0.035. Conclusions: We identified multiple predictors of 6-month readmission in our retrospective cohort, which may help stakeholders to identify opportunities to reduce readmission rates for terminal cancer patients.

scholarly journals Palliative Care in Advanced Dementia: Comparison of Strategies in Three Countries

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 44
Author(s):  
Shelley A. Sternberg ◽  
Shiri Shinan-Altman ◽  
Ladislav Volicer ◽  
David J. Casarett ◽  
Jenny T. van der Steen
Keyword(s):  
Palliative Care ◽  
The Netherlands ◽  
Hospice Care ◽  
The United States ◽  
Artificial Nutrition ◽  
Advanced Dementia ◽  
Case Scenario ◽  
Artificial Nutrition And Hydration ◽  
Positive Elements ◽  
The Us

Palliative care including hospice care is appropriate for advanced dementia, but policy initiatives and implementation have lagged, while treatment may vary. We compare care for people with advanced dementia in the United States (US), the Netherlands, and Israel. We conducted a narrative literature review and expert physician consultation around a case scenario focusing on three domains in the care of people with advanced dementia: (1) place of residence, (2) access to palliative care, and (3) treatment. We found that most people with advanced dementia live in nursing homes in the US and the Netherlands, and in the community in Israel. Access to specialist palliative and hospice care is improving in the US but is limited in the Netherlands and Israel. The two data sources consistently showed that treatment varies considerably between countries with, for example, artificial nutrition and hydration differing by state in the US, strongly discouraged in the Netherlands, and widely used in Israel. We conclude that care in each country has positive elements: hospice availability in the US, the general palliative approach in the Netherlands, and home care in Israel. National Dementia Plans should include policy regarding palliative care, and public and professional awareness must be increased.

scholarly journals FRI0434 PREDICTIVE FACTORS OF SERIOUS INFECTIONS IN PATIENTS WITH CHRONIC INFLAMMATORY ARTHRITIS ON TREATMENT WITH TNF INHIBITORS: REAL LIFE DATA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 815.1-815
Author(s):  
A. Ruiz Ochoa ◽  
J. Escudero Argaluza ◽  
B. Alvarez Rodríguez ◽  
M. Vasques Rocha ◽  
C. Stoye ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Associated Factors ◽  
Statistical Tests ◽  
Univariate Analysis ◽  
Real Life ◽  
Tnf Inhibitors ◽  
Charlson Index ◽  
Multivariable Logistic Regression Model ◽  
Serious Infections ◽  
Usual Clinical Practice

Background:Serious infections are one of the most feared adverse events in patients treated with biologics. To this regard data coming from randomized and long-term extension studies may not totally applied to the usual clinical practice due to the different profile of the treated patients. To study the associated factors for serious infections in patients with inflammatory arthritis treated with TNF inhibitorsObjectives:To study the associated factors for serious infections in patients with inflammatory arthritis treated with TNF inhibitorsMethods:All the medical records of the patients with inflammatory arthritis being treated with TNF inhibitors at the beginning of 2016 were retrospectively reviewed. All serious infections suffered for these patients until the end of 2018 were recorded. Serious infections were defined as those which required to admitted at the hospital for intravenous treatment. Potential variables associated with the development of these infections including: demographic and clinical characteristics, concomitant treatments or comorbidity (by Charlson index) were studied. Standard statistical tests for descriptive and univariate analyses were used and a multivariable logistic regression model was built to check independent associations.Results:Overall 334 patients (50.3% women) with a mean age of 56.67 (±12.853) were studied: 140 (41.92%) Rheumatoid arthritis (RA), 55 (16.46%) psoriatic arthritis (PsA) and 138 (41.62%) spondyloarthritis (Sp). Forty-five serious infections were observed in 30 patients, being respiratory (40%) and urinary (8.8%) the most frequent localizations. Only one patient died. By univariate analysis, disease duration, age, concomitan use of glucocorticoids (GC) (but not of synthetic DMARDs), Charlson index and specifically Diabetes Mellitus were associated with infection (p< 0.05). The type of arthritis was not associated and the results in the subset of RA patients were overall similar. In the multivariate analysis the use of GC [OR: 5.31 (1.98.14.26)] and the Charlson index [OR:2.48 (1.70;3.60)] were found to be independently associated to infection.Conclusion:In patients with inflammatory arthritis and treated with TNF inhibitors around a 10% developed any serious infection along three years of follow up. Use of GC and comorbidity emerged as the main risk factors for this complication.Disclosure of Interests:None declared

Cannabis and End-of-Life Care: A Snapshot of Hospice Planning and Experiences Among Illinois Medical Cannabis Patients With A Terminal Diagnosis

2021 ◽  
pp. 104990912110186
Author(s):  
James Alton Croker ◽  
Julie Bobitt ◽  
Sara Sanders ◽  
Kanika Arora ◽  
Keith Mueller ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Fast Track ◽  
Hospice Care ◽  
Cannabis Use ◽  
Care Plan ◽  
Medical Cannabis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Eol Care

Introduction: Between 2013 and 2019, Illinois limited cannabis access to certified patients enrolled in the Illinois Medical Cannabis Program (IMCP). In 2016, the state instituted a fast-track pathway for terminal patients. The benefits of medicinal cannabis (MC) have clear implications for patients near end-of-life (EOL). However, little is known about how terminal patients engage medical cannabis relative to supportive care. Methods: Anonymous cross-sectional survey data were collected from 342 terminal patients who were already enrolled in ( n = 19) or planning to enroll ( n = 323) in hospice for EOL care. Logistic regression models compare patients in the sample on hospice planning vs. hospice enrollment, use of palliative care vs. hospice care, and use standard care vs non-hospice palliative care. Results: In our sample, cancer patients ( OR = 0.21 (0.11), p < .01), and those who used the fast-track application into the IMCP ( OR = 0.11 (0.06), p < .001) were less likely to be enrolled in hospice. Compared to patients in palliative care, hospice patients were less likely to report cancer as their qualifying condition ( OR = 0.16 (0.11), p < .01), or entered the IMCP via the fast-track ( OR = 0.23 (0.15), p < .05). Discussion: Given low hospice enrollment in a fairly large EOL sample, cannabis use may operate as an alternative to supportive forms of care like hospice and palliation. Clinicians should initiate conversations about cannabis use with their patients while also engaging EOL Care planning discussions as an essential part of the general care plan.

scholarly journals Direct Versus Calculated LDL Cholesterol and C-Reactive Protein in Cardiovascular Disease Risk Assessment in the Framingham Offspring Study

2019 ◽  
Vol 65 (9) ◽  
pp. 1102-1114 ◽  
Author(s):  
Hiroaki Ikezaki ◽  
Virginia A Fisher ◽  
Elise Lim ◽  
Masumi Ai ◽  
Ching-Ti Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Ldl Cholesterol ◽  
Disease Risk ◽  
Univariate Analysis ◽  
Significant Risk ◽  
C Reactive Protein ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
Standard Risk

AbstractBACKGROUNDIncreases in circulating LDL cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP) concentrations are significant risk factors for cardiovascular disease (CVD). We assessed direct LDL-C and hsCRP concentrations compared to standard risk factors in the Framingham Offspring Study.METHODSWe used stored frozen plasma samples (−80 °C) obtained after an overnight fast from 3147 male and female participants (mean age, 58 years) free of CVD at cycle 6 of the Framingham Offspring Study. Overall, 677 participants (21.5%) had a CVD end point over a median of 16.0 years of follow-up. Total cholesterol (TC), triglyceride (TG), HDL cholesterol (HDL-C), direct LDL-C (Denka Seiken and Kyowa Medex methods), and hsCRP (Dade Behring method) concentrations were measured by automated analysis. LDL-C was also calculated by both the Friedewald and Martin methods.RESULTSConsidering all CVD outcomes on univariate analysis, significant factors included standard risk factors (age, hypertension, HDL-C, hypertension treatment, sex, diabetes, smoking, and TC concentration) and nonstandard risk factors (non-HDL-C, direct LDL-C and calculated LDL-C, TG, and hsCRP concentrations). On multivariate analysis, only the Denka Seiken direct LDL-C and the Dade Behring hsCRP were still significant on Cox regression analysis and improved the net risk reclassification index, but with modest effects. Discordance analysis confirmed the benefit of the Denka Seiken direct LDL-C method for prospective hard CVD endpoints (new-onset myocardial infarction, stroke, and/or CVD death).CONCLUSIONSOur data indicate that the Denka Seiken direct LDL-C and Dade Behring hsCRP measurements add significant, but modest, information about CVD risk, compared to standard risk factors and/or calculated LDL-C.

scholarly journals 523. COVID-19 Preparedness in Hospice and Palliative Care

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S328-S328
Author(s):  
Monika Pogorzelska-Maziarz ◽  
Jeannette Kates ◽  
Jingjing Shang ◽  
Angela M Gerolamo
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Group Discussion ◽  
Discussion Board ◽  
Community Group ◽  
Care Community ◽  
Care Services ◽  
Do It Yourself ◽  
Hospice And Palliative Care ◽  
The Impact

Abstract Background Due to the emergence of COVID-19 and resulting pandemic, there is an increased demand for palliative care and hospice care services. However, the impact of COVID-19 on the hospice and palliative agencies is unknown. Methods An electronic survey was disseminated via the Hospice & Palliative Nurses Association newsletter, posted to the Sigma Theta Tau Hospice and Palliative Care Community Group discussion board and advertised through social media from May 7–28, 2020. Summary statistics were computed. Results We collected 36 surveys representing all U.S. regions. Most respondents (78%) reported that their agency has cared for confirmed COVID-19 patients. Only half of agencies had access to laboratory facilities for surveillance and detection of the presence of outbreaks in both patients and staff (58%) and the ability to test patients and providers for COVID-19 (55%). Due to COVID-19, participants stated that the agency added new protocols regarding aerosol-generating procedures policies (58%), use of surface barriers (61%) and PPE usage (e.g. donning and doffing) in patient homes (56%). The majority (76%) reported that their agency required field clinicians to call ahead to ascertain COVID-19 exposure/symptoms before a home visit. More than half (58%) reported that their agency lacked supplies, including N95 respirators (45%), cleaning/disinfectant product (23%), alcohol based sanitizer (18%), eye protection (18%), gowns (18%), and surgical masks (14%). Overall, participants shared that field clinicians had to reuse (76%), extend (73%) or ration (30%) PPE supplies. Respondents reported that their agency accessed supplemental PPE through state/local resources (67%), private/community donations (67%), and do-it-yourself efforts (55%). One third (31%) reported that their agency was experiencing staffing shortages due to COVID-19; of these, 60% reported that shortages were due to staff infected with/quarantined due to COVID-19. Conclusion Our findings suggest that COVID-19 has presented significant challenges for palliative care and hospice agencies as they provide care to patients and families at an unprecedented rate. Disclosures All Authors: No reported disclosures

Cost effectiveness in palliative care setting

2018 ◽  
Vol 21 (2) ◽  
pp. 62-71
Author(s):  
Henry O’Lawrence ◽  
Rohan Chowlkar
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Hospice Care ◽  
Home Health ◽  
Data Set ◽  
Content Type ◽  
Care Services ◽  
The Cost

Purpose The purpose of this paper is to determine the cost effectiveness of palliative care on patients in a home health and hospice setting. Secondary data set was utilized to test the hypotheses of this study. Home health care and hospice care services have the potential to avert hospital admissions in patients requiring palliative care, which significantly affects medicare spending. With the aging population, it has become evident that demand of palliative care will increase four-fold. It was determined that current spending on end-of-life care is radically emptying medicare funds and fiscally weakening numerous families who have patients under palliative care during life-threatening illnesses. The study found that a majority of people registering for palliative and hospice care settings are above the age group of 55 years old. Design/methodology/approach Different variables like length of stay, mode of payment and disease diagnosis were used to filter the available data set. Secondary data were utilized to test the hypothesis of this study. There are very few studies on hospice and palliative care services and no study focuses on the cost associated with this care. Since a very large number of the USA, population is turning 65 and over, it is very important to analyze the cost of care for palliative and hospice care. For the purpose of this analysis, data were utilized from the National Home and Hospice Care Survey (NHHCS), which has been conducted periodically by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Descriptive statistics, χ2 tests and t-tests were used to test for statistical significance at the p<0.05 level. Findings The Statistical Package for Social Sciences (SPSS) was utilized for this result. H1 predicted that patients in the age group of 65 years and up have the highest utilization of home and hospice care. This study examined various demographic variables in hospice and home health care which may help to evaluate the cost of care and the modes of payments. This section of the result presents the descriptive analysis of dependent, independent and covariate variables that provide the overall national estimates on differences in use of home and hospice care in various age groups and sex. Research limitations/implications The data set used was from the 2007 NHHCS survey, no data have been collected thereafter, and therefore, gap in data analysis may give inaccurate findings. To compensate for this gap in the data set, recent studies were reviewed which analyzed cost in palliative care in the USA. There has been a lack of evidence to prove the cost savings and improved quality of life in palliative/hospice care. There is a need for new research on the various cost factors affecting palliative care services as well as considering the quality of life. Although, it is evident that palliative care treatment is less expensive as compared to the regular care, since it eliminates the direct hospitalization cost, but there is inadequate research to prove that it improves the quality of life. A detailed research is required considering the additional cost incurred in palliative/hospice care services and a cost-benefit analysis of the same. Practical implications While various studies reporting information applicable to the expenses and effect of family caregiving toward the end-of-life were distinguished, none of the previous research discussed this issue as their central focus. Most studies addressed more extensive financial effect of palliative and end-of-life care, including expenses borne by the patients themselves, the medicinal services framework and safety net providers or beneficent/willful suppliers. This shows a significant hole in the current writing. Social implications With the aging population, it has become evident that demand of palliative/hospice care will increase four-fold. The NHHCS have stopped keeping track of the palliative care requirements after 2007, which has a negative impact on the growing needs. Cost analysis can only be performed by analyzing existing data. This review has recognized a huge niche in the evidence base with respect to the cost cares of giving care and supporting a relative inside a palliative/hospice care setting. Originality/value The study exhibited that cost diminishments in aggressive medications can take care of the expenses of palliative/hospice care services. The issue of evaluating result in such a physically measurable way is complicated by the impalpable nature of large portions of the individual components of outcome. Although physical and mental well-being can be evaluated to a certain degree, it is significantly more difficult to gauge in a quantifiable way, the social and profound measurements of care that help fundamentally to general quality of care.

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