Ten-Year Trends of Utilization of Palliative Care Services and Life-Sustaining Treatments and Hospital Costs Associated With Patients With Terminally Ill Lung Cancer in the United States From 2005 to 2014

2019 ◽  
Vol 36 (12) ◽  
pp. 1105-1113 ◽  
Author(s):  
Jinwook Hwang ◽  
Jay Shen ◽  
Sun Jung Kim ◽  
Sung-Youn Chun ◽  
Mutsumi Kioka ◽  
...  
Keyword(s):  
United States ◽  
Lung Cancer ◽  
Palliative Care ◽  
Hospital Cost ◽  
Statistical Significance ◽  
Hospital Costs ◽  
The United States ◽  
Care Services ◽  
Dying Patients ◽  
Palliative Care Services

Background: Palliative care services and life-sustaining treatments are provided to dying patients with lung cancer in the United States. However, data on the utilization trends of palliative care services and life-sustaining treatments of dying patients with lung cancer are not available. Methods: This study was a retrospective analysis of the National Inpatient Sample data (2005-2014) and included patients with lung cancer, aged ≥ 18 years, who died in the hospitals. Claims data of palliative care services and life-sustaining treatments that contained systemic procedures, local procedures, or surgeries were extracted. Compound annual growth rates (CAGRs) using Rao-Scott correction for χ2 tests were used to determine the statistical significance of temporal utilization trends of palliative care services and life-sustaining treatments and their hospital costs. Multilevel multivariate regressions were performed to identify factors associated with hospital costs. Results: A total of 120 144 weighted patients with lung cancer died in the hospitals and 41.9% of them received palliative care services. The CAGRs of systemic procedures, local procedures, surgeries, palliative care services, and hospital cost were 3.42%, 3.48%, 6.08%, 18.5%, and 5.0% (all P < .001), respectively. Increased hospital cost was attributed to systemic procedures (50.6%), local procedures (74.4%), and surgeries (68.5%; all P < .001), respectively. Palliative care services were related to decreasing hospital costs by 28.6% ( P < .001). Conclusion: The temporal trends of palliative care services indicate that their utilization has increased gradually. Palliative care services were associated with reduced hospital costs. However, life-sustaining treatments were associated with increased hospital costs.

scholarly journals Drivers of care costs and quality in the last 3 months of life among older people receiving palliative care: A multinational mortality follow-back survey across England, Ireland and the United States

2020 ◽  
Vol 34 (4) ◽  
pp. 513-523 ◽  
Author(s):  
Deokhee Yi ◽  
Bridget M Johnston ◽  
Karen Ryan ◽  
Barbara A Daveson ◽  
Diane E Meier ◽  
...  
Keyword(s):  
United States ◽  
Palliative Care ◽  
Home Care ◽  
Service Use ◽  
The United States ◽  
Care Services ◽  
Health And Social Care ◽  
Total Care ◽  
Palliative Care Services ◽  
Care Costs

Background: Care costs rise towards the end of life. International comparison of service use, costs and care experiences can inform quality and improve access. Aim: The aim of this study was to compare health and social care costs, quality and their drivers in the last 3 months of life for older adults across countries. Null hypothesis: no difference between countries. Design: Mortality follow-back survey. Costs were calculated from carers’ reported service use and unit costs. Setting: Palliative care services in England (London), Ireland (Dublin) and the United States (New York, San Francisco). Participants: Informal carers of decedents who had received palliative care participated in the study. Results: A total of 767 questionnaires were returned: 245 in England, 282 in Ireland and 240 in the United States. Mean care costs per person with cancer/non-cancer were US$37,250/US$37,376 (the United States), US$29,065/US$29,411 (Ireland), US$15,347/US$16,631 (England) and differed significantly ( F = 25.79/14.27, p < 0.000). Cost distributions differed and were most homogeneous in England. In all countries, hospital care accounted for > 80% of total care costs; community care 6%–16%, palliative care 1%–15%; 10% of decedents used ~30% of total care costs. Being a high-cost user was associated with older age (>80 years), facing financial difficulties and poor experiences of home care, but not with having cancer or multimorbidity. Palliative care services consistently had the highest satisfaction. Conclusion: Poverty and poor home care drove high costs, suggesting that improving community palliative care may improve care value, especially as palliative care expenditure was low. Major diagnostic variables were not cost drivers. Care costs in the United States were high and highly variable, suggesting that high-cost low-value care may be prevalent.

Microethical & Relational Insights from Pediatric Palliative Care

2020 ◽  
Vol 7 (4) ◽  
pp. 94-96
Author(s):  
Dr. Abhijit Shinde ◽  
Dr. Sunil Natha Mhaske ◽  
Dr. Ramesh Kothari ◽  
Dr. Sonal Shinde
Keyword(s):  
United States ◽  
Palliative Care ◽  
End Of Life ◽  
The United States ◽  
Pediatric Palliative Care ◽  
Live Births ◽  
Care Services ◽  
Palliative Care Services ◽  
Life Threatening ◽  
Developed World

In the India, more than 30 per 1000 live births of infants die each year before, during, or after birth as do many children with life- limiting conditions. In most countries in the developed world including the United States, the vast majority of infants, children and teenagers at end of life do not have access to multidisciplinary pediatric palliative care services in their community or at a children’shospital. Pediatric palliative care is for children and teenagers suffering from life- threatening or life-limiting conditions in which survival into adulthood is or may be jeopardized if curative treatments  fail. As a result, pediatric palliative care may last over many years.

scholarly journals Comparing the use and timing of palliative care services in COPD and lung cancer: a population-based survey

2018 ◽  
Vol 51 (5) ◽  
pp. 1702405 ◽  
Author(s):  
Charlotte Scheerens ◽  
Kim Beernaert ◽  
Peter Pype ◽  
Joachim Cohen ◽  
Luc Deliens ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Population Based ◽  
Care Services ◽  
Palliative Care Services ◽  
Population Based Survey

Issues for General Practitioners Caring for Dying Patients in the Home

1999 ◽  
Vol 5 (2) ◽  
pp. 9 ◽  
Author(s):  
Annette Street ◽  
Jeanine Blackford ◽  
Anne Turley ◽  
Judy Kelso
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Terminally Ill ◽  
Team Approach ◽  
Fee For Service ◽  
Quality Health Care ◽  
Care Services ◽  
Dying Patients ◽  
Palliative Care Services ◽  
Counselling Program

General practitioners have a central role in the provision of quality health care to the terminally ill patient and family in their own homes. Staff from the Department of Human Services were concerned that GPs were experiencing stress through their increasing role in the provision of palliative care and that there was a need for a fee-for-service stress counselling program for them. A small qualitative study was conducted to verify this perceived need. Semi-structured telephone interviews were conducted with 50 GPs selected from a sample of metropolitan attendees at postgraduate educational activities or doctors known to palliative care services. GPs faced a number of issues in their care for terminally ill people in the community but a fee-for-service counselling program was deemed unnecessary. Evidence from the study confirmed that effective communication strategies between GPs, palliative care services and acute hospitals, an interdisciplinary team approach, and improved understanding between health professionals would enhance the quality of care for dying people and their caregivers.

Integration of palliative care services into standard oncology practice at diagnosis of metastatic lung cancer at VA New York Harbor Healthcare System.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 165-165
Author(s):  
Felix Manuel Rivera Mercado ◽  
Carol Luhrs ◽  
Alice Beal ◽  
Maura Langdon ◽  
Joan Secrest ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Stage Iv ◽  
Major Advance ◽  
Metastatic Lung Cancer ◽  
Care Services ◽  
National Quality ◽  
Metastatic Lung ◽  
Palliative Care Services ◽  
Oncology Practice

165 Background: The 2012 ASCO provisional clinical opinion addressed the integration of palliative care into standard oncology practice at the time a person is diagnosed with metastatic or advanced cancer. The inclusion of Palliative Care among the National Quality Forum (NQF) framework represented a major advance in palliative care. NQF metrics include chemotherapy administered in the last 14 days of life, hospice less than 3 days before death, ICU or hospital admission, more than one Emergency Room visit in the last 30 days, and death in hospital. Although the use of hospice and other palliative care services has increased, many are enrolled in hospice less than 3 weeks before death. By improving quality of life, cost, and survival in patients with metastatic cancer, palliative care has increasing relevance for the care of patients with cancer. Methods: Retrospective chart review study of lung cancer patients diagnosed at VA from 2010-2013. Inclusion criteria: > 18 years of age with new diagnosis of metastatic lung cancer. Exclusion criteria: < 18 years of age, Stage I-III lung cancer. Results: Total of 125 patients were diagnosed with Stage IV lung cancer. The mean time from diagnosis to death was only 185 days (6.1 months). The VA NYHHS patients were more likely to visit the ED, be admitted to the hospital and ICU in the last 30 days of life, and subsequently die in the hospital. Conclusions: Several confounders were identified, including climate related closure of facilities (2012 Sandy storm), lack of social support, low ICU admission criteria, burial benefits for patients dying in a VA, and delay in transition to Hospice. Currently 392 patients with stage IV solid tumors diagnosed 2010-2014 are being studied. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document