scholarly journals Continuity in palliative care – analysis of intersectoral palliative care based on routine data of a statutory health insurance

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Laura Rehner ◽  
Kilson Moon ◽  
Wolfgang Hoffmann ◽  
Neeltje van den Berg
Keyword(s):  
Palliative Care ◽  
Health Insurance ◽  
Statutory Health Insurance ◽  
Routine Data ◽  
Chi Square ◽  
Discharge Management ◽  
Care Training ◽  
Discharge From Hospital ◽  
Ambulatory Health Care

Abstract Background The goal of palliative care is to prevent and alleviate a suffering of incurable ill patients. A continuous intersectoral palliative care is important. The aim of this study is to analyse the continuity of palliative care, particularly the time gaps between hospital discharge and subsequent palliative care as well as the timing of the last palliative care before the patient’s death. Methods The analysis was based on claims data from a large statutory health insurance. Patients who received their first palliative care in 2015 were included. The course of palliative care was followed for 12 months. Time intervals between discharge from hospital and first subsequent palliative care as well as between last palliative care and death were analysed. The continuity in palliative care was defined as an interval of less than 14 days between palliative care. Data were analysed using descriptive statistics and Chi-Square. Results In 2015, 4177 patients with first palliative care were identified in the catchment area of the statutory health insurance. After general inpatient palliative care, 415 patients were transferred to subsequent palliative care, of these 67.7% (n = 281) received subsequent care within 14 days. After a stay in a palliative care ward, 124 patients received subsequent palliative care, of these 75.0% (n = 93) within 14 days. Altogether, 147 discharges did not receive subsequent palliative care. During the 12-months follow-up period, 2866 (68.7%) patients died, of these 78.7% (n = 2256) received palliative care within the last 2 weeks of life. Of these, 1223 patients received general ambulatory palliative care, 631 patients received specialised ambulatory palliative care, 313 patients received their last palliative care at a hospital and 89 patients received it in a hospice. Conclusions The majority of the palliative care patients received continuous palliative care. However, there are some patients who did not receive continuous palliative care. After inpatient palliative care, each patient should receive a discharge management for a continuation of palliative care. Readmissions of patients after discharge from inpatients palliative care can be an indication for a lack of support in the ambulatory health care setting and for an insufficient discharge management. Palliative care training and possibilities for palliative care consultations by specialists should strengthen the GPs in palliative care.

scholarly journals Comparison of Survival Between Patients Receiving General Ambulatory Palliative Care and Patients Receiving Other Palliative Care - Analysis of Data of a Statutory Health Insurance Data

2021 ◽  
Author(s):  
Kilson Moon ◽  
Laura Rehner ◽  
Wolfgang Hoffmann ◽  
Neeltje van den Berg
Keyword(s):  
Palliative Care ◽  
Health Insurance ◽  
Median Survival ◽  
Statutory Health Insurance ◽  
Survival Curves ◽  
Specialized Care ◽  
Group A ◽  
One Year ◽  
Group B

Abstract Background The care of palliative patients takes place as non-specialized and specialized care, in both ambulatory and stationary settings. However, palliative care is largely provided as non-specialized care in the ambulatory sector (AAPV). This study aimed to investigate whether the survival curves of AAPV patients differed from those of the more intensive palliative care modalities and whether AAPV palliative care was appropriate in terms of timing.Methods The study is based on claims data from a large statutory health insurance. The analysis included 4,177 patients who received palliative care starting in 2015 and who were fully insured one year before and one year after palliative care or until death. The probability of survival was observed for 12 months. Patients were classified into group A, which consisted of patients who received palliative care only with AAPV, and group B including patients who received stationary or specialized ambulatory palliative care. Group A was further divided into two subgroups. Patients who received AAPV on only 1 day were assigned to Subgroup A1, and patients who received AAPV on two or more days were assigned to Subgroup A2. The survival analysis was carried out using Kaplan-Meier curves. The median survival times were compared with the log-rank test.Results The survival curves differed between groups A and B, except in the first quartile of the survival distribution. The median survival was significantly longer in group A (137 days, n=2,763) than in group B (47 days, n=1,424, p<0.0001) and shorter in group A1 (35 days, n=986) than in group A2 (217 days, n=1,767, p<0.0001). The survival rate during the 12-month follow-up was higher in group A (42%) than in group B (11%) and lower in group A1 (38%) than in group A2 (44%).Conclusions The results of the analysis revealed that patients who received the first palliative care shortly before death suspected insufficient care, especially patients who received AAPV for only 1 day and no further palliative care until death or 12-month follow-up. Palliative care should start as early as necessary and be continuous until the end of life.

scholarly journals Replacement of endoprosthetic implants within a two years follow-up period: a statutory health insurance routine data analysis

2012 ◽  
Vol 13 (1) ◽  
Author(s):  
Roland Linder ◽  
Hardy Müller ◽  
Brigitte Grenz-Farenholtz ◽  
Caroline Wagner ◽  
Martin Stockheim ◽  
...  
Keyword(s):  
Health Insurance ◽  
Data Analysis ◽  
Statutory Health Insurance ◽  
Routine Data

Impact of palliative care clinic (PCC) referrals on pain control in genitourinary (GU) cancer patients: Retrospective analysis at Roswell Park Cancer Institute (RPCI).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 57-57
Author(s):  
Neha Gupta ◽  
Shipra Gandhi ◽  
Sidra Anwar ◽  
Katy Wang ◽  
Yashodhara Satchidanand
Keyword(s):  
Palliative Care ◽  
Pain Score ◽  
Cancer Patients ◽  
Retrospective Review ◽  
Pain Control ◽  
Medical Oncology ◽  
Screening Tools ◽  
Chi Square ◽  
Care Clinic

57 Background: Many cancer patients (pts) with GU cancer suffer from uncontrolled pain, and may benefit from more focused palliative care. We assessed the frequency and impact of specialist PCC referrals on pain management of our GU Medical oncology clinic (GUMOC) pts. Methods: 239 consecutive pts were collected from a retrospective review of GUMOC records from 12/1/2013 to 2/28/2014. This group of pts was used to assess the frequency of PCC referral. Pts were divided into two arms- Arm A= GUMOC pts referred to PCC; Arm B: GUMOC pts not referred to PCC. To be able to detect a 15% between the two arms at 95% significance, 37 additional pts (who were already being seen at GUMOC) were collected from retrospective review of PCC records over 9/1/2013 to 2/28/2014. Total 276 pts were divided into Arm A (n=49), Arm B (n=227 pts). Data for baseline pain score and 4-week follow up pain scores were collected. A palliative care screening tool (retrieved from Center to Advance Palliative care [CAPC] website) was used to assign palliative care screening score (PCSS) to all study pts. Chi square test and T-test were used for statistical analysis. Results: Out of the 239 initially collected GUMOC pts, 5% were referred to PCC. 10% (n=24) had PCSS score of ≥ 4, and 33% pts with PCSS ≥ 4 were referred to PCC. Arm A had worse baseline symptoms, ECOG status and more advanced cancer stage. 4-week pain score follow up revealed significant improvement in Arm A -2.74 vs. Arm B -0.13 (p<0.01). Conclusions: GU cancer pts who are referred to PCC from medical oncology clinic have significant decrease in pain symptoms. Frequency of PCC consultation is still low in comprehensive cancer institutes, and not in congruence with the available palliative care screening tools criteria suggested by CAPC. Standardized tools should be developed to guide PCC referrals, and routine use of these tools will significantly help in pain control by seeking specialist palliative care.

scholarly journals Treatment Costs of Matrix-Associated Autologous Chondrocyte Implantation Compared With Microfracture: Results of a Matched-Pair Claims Data Analysis on the Treatment of Cartilage Knee Defects in Germany

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988658
Author(s):  
Philipp Niemeyer ◽  
Tino Schubert ◽  
Marco Grebe ◽  
Arnd Hoburg
Keyword(s):  
Health Insurance ◽  
Autologous Chondrocyte Implantation ◽  
Claims Data ◽  
Statutory Health Insurance ◽  
Cartilage Damage ◽  
Treatment Costs ◽  
Chondrocyte Implantation ◽  
Additional Costs ◽  
Autologous Chondrocyte

Background: Articular cartilage damage is caused by traumatic sport accidents or age-related degeneration and might lead to osteoarthritis, which represents a socioeconomic burden to society. Cartilage damage in the knee is commonly treated surgically with microfracture (MFX) or matrix-associated autologous chondrocyte implantation (MACI). Purpose: To quantify the initial and follow-up costs associated with MFX and MACI treatments from the viewpoint of statutory health insurance in Germany. Study Design: Economic decision analysis; Level of evidence, 2. Methods: This comparative study was based on an anonymized representative claims data set of 4 million patients covered by statutory health insurance in Germany. Patients undergoing outpatient or inpatient treatment with MACI or MFX for cartilage damage in the knee between January 1, 2012, and December 31, 2013, were included and evaluated over 5 years. Groups (MACI and MFX) were adjusted via propensity score matching before initial treatment. The matched groups were compared regarding their outpatient, inpatient, pharmaceutical, and other costs during the 5-year period. Results: In total, 127 patients per group were analyzed (59.1% male, 40.9% female; mean age, 37 years). In the year of the initial surgical procedure, costs were €14,804.13 in the MACI group and €5458.59 in the MFX group. In years 2 and 3 after initial surgery, treatment costs were comparable between patients treated with MACI (€2897.97 and €2114.87, respectively) and MFX (€2842.66 and €1967.42, respectively), with slightly higher treatment costs for those treated with MACI. In years 4 and 5 after surgery, costs were less in patients treated with MACI (€2154.79 and €1478.08, respectively) than in those treated with MFX (€2232.57 and €2061.63, respectively). Costs related to revision surgery were, on average, €3732 for MACI and €3765 for MFX. Thus, additional costs in years with revision surgery were €1672 for MACI and €1915 for MFX. Conclusion: This was the first study to analyze a large representative population claims database with propensity score matching, and results indicated that follow-up costs of patients treated with MACI and MFX began to converge over time. We found that total costs for MACI were higher than for MFX but that additional costs for MACI were lower than previously reported. Perceived morbidity may have little to do with cost.

scholarly journals Epidemiology and One-Year Follow-Up of Neonates with CDH-Data from Health Insurance Claims in Germany

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 160
Author(s):  
Boris Wittekindt ◽  
Nora Doberschuetz ◽  
Andrea Schmedding ◽  
Till-Martin Theilen ◽  
Rolf Schloesser ◽  
...  
Keyword(s):  
Health Insurance ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Routine Data ◽  
Outcome Data ◽  
Insurance Fund ◽  
Clinical Registries ◽  
Specialized Care ◽  
One Year

Congenital diaphragmatic hernia (CDH) is a major congenital malformation with high mortality. Outcome data on larger unselected patient groups in Germany are unavailable as there is no registry for CDH. Therefore, routine data from the largest German health insurance fund were analyzed for the years 2009–2013. Main outcome measures were incidence, survival and length of hospital stay. Follow-up was 12 months. 285 patients were included. The incidence of CDH was 2.73 per 10,000 live births. Overall mortality was 30.2%. A total of 72.1% of the fatalities occurred before surgery. Highest mortality (64%) was noted in patients who were admitted to specialized care later as the first day of life. Patients receiving surgical repair had a better prognosis (mortality: 10.8%). A total of 67 patients (23.5%) were treated with ECMO with a mortality of 41.8%. The median cumulative hospital stay among one-year survivors was 40 days and differed between ECMO- and non-ECMO-treated patients (91 vs. 32.5 days, p < 0.001). This is the largest German cohort study of CDH patients with a one-year follow-up. The ECMO subgroup showed a higher mortality. Another important finding is that delayed treatment in specialized care increases mortality. Prospective clinical registries are needed to elucidate the treatment outcomes in detail.

scholarly journals Evaluation of Online Palliative Care Training for Certified Nursing Assistants

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 521-521
Author(s):  
Jinsook Kim ◽  
Jennifer Gray
Keyword(s):  
Palliative Care ◽  
Self Efficacy ◽  
Nursing Assistants ◽  
Control Group ◽  
Certified Nursing Assistants ◽  
Comfort Care ◽  
Significant Difference ◽  
Care Training ◽  
Experimental Group

Abstract Palliative care for older adults is increasingly needed due to a burgeoning older adult population. Certified nursing assistants (CNAs) in skilled nursing facilities (SNFs) provide assistance with activities of daily living and comfort care. There, however, is a significant gap in evaluated palliative care trainings for CNAs. We used a waitlisted control group design to evaluate the effectiveness of an 8-module online palliative care training. CNAs (n=102) from 6 SNFs were randomly assigned to an experimental (n=51) and a control group (n=51) and completed a baseline evaluation. The experimental group took a posttest about palliative care knowledge upon training completion and a 1-month follow-up assessment about palliative care self-efficacy. The control group completed the assessments at the same time as the experimental group prior to receiving the training. The majority of the participants were female (92%). On average, participants were 31 years old, with 6.5 years tenure in the field. The retention rate was 90% at the posttest (n=92) and 82% at the 1-month follow-up (n=84). Palliative care knowledge (scored 0–100) significantly increased in the experimental group (mean 4.1, p &lt; 05), with no significant change in the control group. Palliative care self-efficacy (scored 20-100) significantly improved from the baseline to follow-up in both groups (mean 4.3 and 5.8 respectively, p &lt; 05) with no significant difference between study groups. The results indicate the effectiveness of an online palliative care training to improve CNA knowledge. Improvement in palliative care self-efficacy regardless of training participation warrants further exploration.

Models of outpatient neuropalliative care for patients with amyotrophic lateral sclerosis

Neurology ◽  
2020 ◽  
Vol 95 (17) ◽  
pp. 782-788 ◽  
Author(s):  
Joel N. Phillips ◽  
Jessica Besbris ◽  
Laura A. Foster ◽  
Neha M. Kramer ◽  
Samuel Maiser ◽  
...  
Keyword(s):  
United States ◽  
Palliative Care ◽  
Amyotrophic Lateral Sclerosis ◽  
The United States ◽  
Routine Care ◽  
Care Training ◽  
Written Descriptions ◽  
To Receive ◽  
Lateral Sclerosis

ObjectiveTo describe some current models of outpatient neuropalliative care (NPC) available to patients with amyotrophic lateral sclerosis at different institutions within the United States.MethodsSix NPC physicians were asked to contribute written descriptions about the PC available in their ALS clinics. Descriptions were then compiled and assessed for similarities and differences.ResultsAll clinics are multidisciplinary, with regular appointments every 3 months and similar appointment times for new visits (60–120 minutes) and follow-up visits (20–45 minutes). Four clinics have an NPC specialist embedded within the ALS clinic, 1 institution has a separate clinic for NPC, and 1 institution has both. The NPC physician at 5 institutions is a neurologist with formal palliative care training and at 1 institution is an internist with formal palliative care training. NPC is part of routine care for all patients at 2 institutions, and the primary reasons for consultation are goals of care (GOC) and severe symptom management.ConclusionNPC is provided to patients with ALS heterogeneously throughout the United States with some variation in services and delivery, but all clinics are addressing similar core needs. Given the poor prognosis and high PC needs, those with ALS are the ideal patients to receive NPC. Future studies are necessary given the paucity of data available to determine best practices and to better define meaningful outcomes.

Hämophiliebehandlung als ganzheitliches Konzept der Patientenversorgung

2012 ◽  
Vol 32 (S 01) ◽  
pp. 25-S28
Author(s):  
H. Rott ◽  
G. Kappert ◽  
S. Halimeh
Keyword(s):  
Health Insurance ◽  
Effective Treatment ◽  
International Research ◽  
Statutory Health Insurance ◽  
Interdisciplinary Team ◽  
Legal Basis ◽  
University Hospitals ◽  
Innovative Treatment ◽  
Social Law ◽  
Treatment Concepts

SummaryA top quality, effective treatment of haemophilia requires an integrated therapeutical concept and an excellent cooperation of an interdisciplinary team. Since years different models are discussed in Germany in order to enlarge the offers for a suitable care of patients with hard to treat diseases. The healthpolitical targets are expressed in the changes of the Code of Social Law number V (SGB V) and in innovations in the statutory health insurance. This new legal basis provides opportunities to implement innovative treatment concepts outside university hospitals and paves the way for ambulant haemophilia centres to offer an integral care, all legally saved by a contract.The Coagulation Centre Rhine-Ruhr reveals as an example how haemophilia treatment in accordance with guidelines and with the latest results of international research can be realise in an ambulatory network.

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