Healthcare utilization among cancer patients prior to hospice.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 135-135
Author(s):  
Emily Miller Ray ◽  
Richard F. Riedel ◽  
Christel N. Rushing ◽  
Anthony N. Galanos
Keyword(s):  
Palliative Care ◽  
Healthcare Utilization ◽  
Solid Tumor ◽  
Medical Oncology ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Integrated Approach ◽  
Inpatient Service ◽  
Invasive Procedures ◽  
Aggressive Approach

135 Background: The integration of palliative medicine in oncologic care has become increasingly recognized and supported. We have previously reported improved health system and quality of care outcomes for solid tumor patients admitted to our novel, fully-integrated palliative care (PC) and medical oncology inpatient service at Duke University Medical Center (DUMC). In this study, we explored healthcare utilization in patients specifically discharged to hospice pre- and post-PC integration. Methods: We conducted a retrospective cohort study of hospitalized patients on the solid tumor unit at DUMC who were discharged to hospice care between September 1, 2009-June 30, 2010 (pre-PC integration) and September 1, 2011-June 30, 2012 (post-PC integration). Cohorts were compared on the following outcome variables occurring within 30 days prior to discharge to hospice: number of hospitalizations, ICU days, ED visits, invasive procedures, subspecialty consultations, radiologic studies, medical oncology clinic visits, and use of chemotherapy or radiation. Wilcoxon rank-sum and Chi square tests were used for statistical analyses. Results: A total of 296 patients were included (133 pre-PC integration; 163 post-PC integration) in the analyses. Patient characteristics were well matched between cohorts. The overall mean age was 63 years (range 25-96), 62% were Caucasian, 51% were male, and 98% of patients had recurrent or metastatic disease. Of particular note, there were no significant differences noted between cohorts with regards to the resource utilization outcome variables assessed. Conclusions: Understanding healthcare utilization in this patient population is of great interest to clinical providers and policymakers alike. While we have previously demonstrated the benefit of integrating palliative care and medical oncology for reducing hospital readmissions and length of stay, this study shows no significant impact of an integrated approach on the utilization of healthcare resources measured within the 30 days prior to discharge to hospice. This may reflect the aggressive approach to management of symptoms for end-of-life patients, which often involves invasive procedures, use of imaging, and other resources to meet their needs.

scholarly journals Assessing the Impact of a Novel Integrated Palliative Care and Medical Oncology Inpatient Service on Health Care Utilization before Hospice Enrollment

2019 ◽  
Vol 22 (4) ◽  
pp. 420-423 ◽  
Author(s):  
Emily M. Ray ◽  
Richard F. Riedel ◽  
Thomas W. LeBlanc ◽  
Christel N. Rushing ◽  
Anthony N. Galanos
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Utilization ◽  
Medical Oncology ◽  
Care Utilization ◽  
Inpatient Service ◽  
The Impact

Palliative care and health care utilization at the end of life.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 152-152
Author(s):  
Daniel P Triplett ◽  
Wendi G LeBrett ◽  
Rayna Matsuno ◽  
Lindsay Hwang ◽  
Isabel Boero ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Healthcare Utilization ◽  
Advanced Cancer ◽  
Care Utilization ◽  
Medicare Beneficiaries ◽  
Invasive Procedures ◽  
Chemotherapy Administration ◽  
Palliative Care Consultation ◽  
Care Consultation

152 Background: Palliative care’s role in oncology has expanded, but its impact on aggressiveness of care at the end of life has not been characterized at the population level. Methods: This matched retrospective cohort study examined the effect of an encounter with palliative care on healthcare utilization at the end of life among 6,580 Medicare beneficiaries with advanced prostate, breast, lung, or colorectal cancer. We compared healthcare utilization before and after palliative care consultation to a matched non-palliative care cohort. Results: The palliative care cohort had higher rates of healthcare utilization in the 30 days prior to palliative care consult compared to the non-palliative cohort, with higher rates of hospitalization (risk ratio [RR] 3.33; 95% CI 2.87-3.85), invasive procedures (RR 1.75; 95% CI 1.62-1.88), and chemotherapy administration (RR 1.61; 95% CI 1.45-1.78). The opposite pattern emerged in the interval from palliative care consultation through death, where the palliative care cohort had lower rates of hospitalization (RR 0.53; 95% CI 0.44-0.65), invasive procedures (RR 0.52; 95% CI 0.45-0.59), and chemotherapy administration (RR 0.46; 95% CI 0.39-0.53). Patients with early palliative care consultation had larger absolute reductions in healthcare utilization compared to those with palliative care consultation closer to the end of life. Conclusions: This population-based study found that palliative care substantially decreased healthcare utilization among Medicare beneficiaries with advanced cancer. Given the increasing number of elderly patients with advanced cancer, this study emphasizes the importance of early integration of palliative care alongside standard oncologic care.

Identifying high-risk features for readmission in patient with metastatic solid tumor malignancies at an academic community hospital.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 217-217
Author(s):  
Nathan Reuben Teich ◽  
Alexander A. Hindenburg
Keyword(s):  
Palliative Care ◽  
High Risk ◽  
Metastatic Disease ◽  
Solid Tumor ◽  
Community Hospital ◽  
Medical Oncology ◽  
Academic Community ◽  
Oncology Patients ◽  
Quality Initiatives ◽  
Metastatic Solid Tumor

217 Background: Readmission of oncology patients to hospitals is an undesirable outcome for both the patient and healthcare system. These can lead to delays in treatment and increased resource utilization. 30-day readmission have been a target of multiple national quality initiatives. Adverse outcomes have been associated with readmission in multiple patient populations. The aim of this study was to perform a qualitative and quantitative analysis on inpatient solid tumor medical oncology readmissions to an academic community hospital. Additionally, identifying additional risk factors for readmission such as need for fluid drainage and rate of palliative care involvement were assessed. Methods: Using ICD-10 codes, 183 patients were identified as being readmitted within 30 days with a known oncological diagnosis from January 2019-Decemember 2019. Only the most recent readmission was included for review. 54 of these patients were selected at random for manual chart review to generate data. Results: In the 54 patients who underwent detailed review, 21 were identified as having stage IV metastatic sold tumor disease primarily under the care of a medical oncology team. Common factors identified for readmission included malignant abdominal ascites (6 patients), thoracic pleural effusions requiring drainage (5 patients), CNS/spinal metastases (4 patients). Palliative care was consulted in the index admission in 48% of cases analyzed. In patients with metastatic solid tumor disease, 17/21 (81%) of patients were discharged on a weekday. Examples of preventable readmissions identified included inadequately treated hypercalcemia of malignancy and cerebral edema due to brain metastases discharged with insufficient corticosteroid dosing. Conclusions: The high-risk features identified (e.g. recurrent malignant ascites) may benefit from novel systems-based approaches (i.e. EMR alerts, daily oncology/palliative care team huddle to discuss high risk patients). Most patients readmitted to the oncology service with metastatic disease were not discharged on a weekend day. This analysis also revealed under-utilization of palliative care during the index admissions for these oncology patients with known metastatic disease. Further quality initiatives will be directed at creation of a risk score for readmission in this subset of patients with high disease burden.

scholarly journals Improvements in Patient and Health System Outcomes Using an Integrated Oncology and Palliative Medicine Approach on a Solid Tumor Inpatient Service

2017 ◽  
Vol 13 (9) ◽  
pp. e738-e748 ◽  
Author(s):  
Richard F. Riedel ◽  
Kim Slusser ◽  
Steve Power ◽  
Christopher A. Jones ◽  
Thomas W. LeBlanc ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Length Of Stay ◽  
Health System ◽  
Solid Tumor ◽  
Medical Oncology ◽  
Inpatient Service ◽  
Readmission Rates ◽  
Fully Integrated

Purpose: Early palliative care (PC) improves outcomes for outpatients with advanced cancer. Its effect on hospitalized patients with cancer is unknown. Herein, we report on the influence of a novel, fully integrated inpatient medical oncology and PC partnership at a tertiary medical center during its first year of implementation. Methods: We conducted a retrospective, longitudinal, pre- and postintervention cohort study at Duke University Hospital. Pre- and postintervention cohorts were defined as all patients admitted to the solid tumor inpatient service from September 1, 2009, to June 30, 2010, and September 1, 2011 to June 30, 2012, respectively. We extracted patient data, including demographics, cancer diagnosis, disease status, length of stay, intensive care unit transfer rate, discharge disposition, time to emergency department return, time to readmission, and 7- and 30-day emergency department return and readmission rates. Nursing and physician surveys assessed satisfaction. Descriptive statistics, and Kruskal-Wallis and Χ2 tests were used to describe and compare cohorts. A generalized estimating equation accounted for repeated measures. Results: Pre- and postintervention analysis cohorts included 731 and 783 patients, respectively, representing a total of 1,514 patients and 2,353 encounters. Cohorts were similar in baseline characteristics. Statistically significant lower odds in 7-day readmission rates were observed in the postintervention cohort (adjusted odds ratio, 0.76; 95% CI, 0.58 to 1.00; P = .0482). Patients in the postintervention group had a decrease in mean length of stay (−0.30 days; 95% CI, −0.62 to 0.02); P = .0651). We observed a trend for increasing hospice referrals ( P = .0837) and a 15% decrease in intensive care unit transfers ( P = .61). Physicians and nurses universally favored the model. Conclusion: A fully integrated inpatient partnership between PC and medical oncology is associated with significant and clinically meaningful improvements in key health system–related outcomes and indicators of quality cancer care.

scholarly journals Early Integration of Palliative Care in Oncology Practice: Results of the Italian Association of Medical Oncology (AIOM) Survey

2016 ◽  
Vol 7 (14) ◽  
pp. 1968-1978 ◽  
Author(s):  
Vittorina Zagonel ◽  
Riccardo Torta ◽  
Vittorio Franciosi ◽  
Antonella Brunello ◽  
Guido Biasco ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Oncology ◽  
Early Integration ◽  
Italian Association ◽  
Oncology Practice

Occupational Stress, Burnout, and Professional Support in Nurses Working with Dying Patients

1996 ◽  
Vol 32 (2) ◽  
pp. 93-109 ◽  
Author(s):  
Anne Plante ◽  
Louise Bouchard
Keyword(s):  
Palliative Care ◽  
Occupational Stress ◽  
Medical Oncology ◽  
Professional Support ◽  
Stress Factors ◽  
Metropolitan Region ◽  
Staff Burnout ◽  
Dying Patients ◽  
The Relationship ◽  
And Training

Nurses working with dying people are exposed to numerous stress factors. Their occupational stress may be so important as to lead to burnout. The aim of the present study is to examine the relationship among occupational stress, burnout, and professional support in nurses working with patients dying from cancer. The study has taken place in four palliative care and three medical oncology units of the Montreal metropolitan region. In all, seventy-six nurses of the N nurses fitting the entrance criteria of the study were selected. Participants completed a French version of the following instruments: the Occupational Stress of Nurses Working with Dying Patients, the Jones Staff Burnout Scale for Health Professionals and the Professional Support Scale. Results indicate that there is a significant relationship between occupational stress and burnout ( r = 0.462, p < 0.001) and between professional support and burnout ( r = −0.449, p < 0.001). Further, the results showed that the level of occupational stress and burnout was significantly lower for the palliative care nurses who received significantly more professional support than their colleagues working in medical oncology units. Professional support and training for nurses working with patients dying from cancer should be implemented in order to minimize the development of burnout.

Experience of Patients in a Consult Model versus an Integrated Palliative Care and Medical Oncology Co-Rounding Model: A Qualitative Study

2021 ◽  
Author(s):  
Grace Meijuan Yang ◽  
Sushma Shivanada ◽  
Cherylyn Foo ◽  
Shirlyn Huishan Neo ◽  
Shirlynn Ho ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Medical Oncology ◽  
Model Versus

Serious illness conversation and end of life care utilization at an academic medical center.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 29-29
Author(s):  
William P. Tompkins ◽  
Christine Agnes Ciunci ◽  
Suzanne Walker ◽  
Kelly Patton ◽  
Amy Schwartz ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Median Time ◽  
Medical Center ◽  
Time Interval ◽  
Inpatient Setting ◽  
Serious Illness ◽  
Life Planning ◽  
End Of Life Planning

29 Background: Hospice has been associated with improved quality of life for patients, cost savings, and reduction in caregiver-grief-related depression. While cancer patients make up a plurality of hospice utilizers nationally, many patients are only on hospice for a limited period (in Medicare patients, a median of 18 days). Studies suggest engaging cancer patients to discuss goals and priorities using the Serious Illness Conversation (SIC) Guide has a positive impact on prognostic understanding and end-of-life planning. More frequent utilization of SICs may prompt earlier enrollment of oncology patients in hospice when appropriate. Methods: We identified cancer patients enrolled in hospice at the Abramson Cancer Center at Penn Presbyterian Medical Center from 2019-2020 after all providers received SIC training. Patient demographics, cancer diagnosis, type of hospice (home versus inpatient), SIC usage, palliative care referral patterns and time on hospice were abstracted. Results: 104 patients were enrolled in hospice during the study period. The majority of patients were female (51%). 45% were Caucasian, and 31% were African American. The most common cancer diagnoses were thoracic (52%) and gastrointestinal (32%) malignancies. 85 patients (82%) were enrolled on home hospice and 19 patients (18%) inpatient hospice. Palliative care usage included 50 inpatient and 24 outpatient consultations; 30 patients (29%) in the cohort never utilized palliative care. 52 (50%) of patients did not have a SIC. 47% (40 patients) enrolled in home hospice had an SIC while 63% (12 patients) on inpatient hospice had an SIC. The median time interval between a patient’s SIC conversation and hospice enrollment was longer in home hospice patients (74 days) compared to inpatient hospice (33 days). Patients on home hospice spent an average of 44 days on hospice versus 2 days in the inpatient setting. Conclusions: Half of the patients at Penn Presbyterian Medical Center enrolled in hospice during the study period did not have an SIC, and 29% did not see palliative care prior to starting hospice. The median time from SIC initiation to hospice enrollment was significantly longer for patients on home hospice compared to inpatient hospice suggesting a need for earlier SIC interventions. Patients enrolled in inpatient hospice spent a considerably shorter period of time on hospice also underscoring the importance of earlier end of life planning. Our findings indicate a need for additional interventions to facilitate earlier SIC conversations in the outpatient setting and a demand for increased palliative care access.

Abstract TP366: Significant Reduction in Readmission Using Transitions Nurse

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kiersten Espaillat ◽  
Paula Buckner
Keyword(s):  
Hospital Discharge ◽  
Transitional Care ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Primary Diagnosis ◽  
Adult Patients ◽  
Care Coordinator ◽  
Readmission Rates ◽  
Before And After

In an effort to reduce early hospital readmissions, Vanderbilt University Medical Center (VUMC) implemented a transitional care coordinator (TCC) to provide careful coordinated follow up care for stroke patients after hospital discharge. The aim of this study is to compare all cause thirty- day readmission rates of adult patients with a primary diagnosis of stroke before and after the implementation of a stroke services TCC. All adult patients admitted to VUMC with a primary diagnosis of stroke; ischemic, hemorrhagic, and TIA; and readmitted within the first thirty days following hospital discharge between January-June of 2015, 2016, 2017, & 2018 were analyzed. Readmission data from 2015 & 2016, prior to the implementation of the TCC was compared to readmission data from 2017 & 2018, after the TCC was implemented. A total of 1911 charts were reviewed for the timeframe January-June of 2015-2018. In 2015 there were 369 stroke admissions and 120 (33%) were readmitted and in 2016 there were 474 stroke admissions and 112 (24%) readmissions, before the TCC role was implemented. In 2017 there were 540 stroke admissions and 62 (11%) were readmitted and in 2018 there were 528 stroke admissions and 74 (14%) readmissions, after the TCC role was implemented. Hospital readmissions were reduced significantly after implementing a TCC.

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