Racial and social disparities on aggressiveness of end-of-life cancer care in a rural academic center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18063-e18063
Author(s):  
Praveen Namireddy ◽  
Shravanti Macherla ◽  
James Thompson McClain ◽  
Mahvish Muzaffar
Keyword(s):  
End Of Life ◽  
Family Support ◽  
Cancer Care ◽  
Hospice Care ◽  
Hospital Admissions ◽  
Medical Center ◽  
Composite Score ◽  
Minority Population ◽  
Icu Admission ◽  
Ed Visits

e18063 Background: Aggressive cancer care at the end of life (EOL) can impact quality of life and have major economic burden. The purpose of this study was to determine the aggressiveness of EOL cancer care, and its relation to race, gender and social factors in Eastern North Carolina with a high rural and minority population. Methods: This is a retrospective analysis of 401 stage 4 solid tumor patients who died between 2011 and 2014 at Vidant Medical Center. Aggressiveness of care was calculated by a composite score adopted from Earle et al. Scores range from 0 to 7 with higher scores indicating more aggressive EOL care. 1 point was given to each indicator of aggressiveness in the last 30 days of life: ED visits ≥2, hospital admissions ≥2, any ICU admission, hospitalized days ≥14, new chemotherapy, hospice care ≤ 3 days, and any chemotherapy in the last 14 days. Results: Among 401 patients, 217 (54%) were white and 178 (44%) were black. The mean composite score for aggressiveness (CSA) for whites was 1.18 and for blacks it was 1.87 (p<0.001). In the last 30 days of life, a higher proportion of blacks had ≥ 2 ED visits 28% vs 13%(p<.0001), ≥ 2 hospital admission 23% vs 13%(p=0.001), any ICU admission 29% vs 16%(p=0.0002), chemotherapy in the last 14 days 30% vs 20%(p=0.001), and ≥ 14 hospitalized days 35% vs 21%(p<0.001) compared to whites. More whites were enrolled in hospice compared to blacks 53% vs 45% (p<0.001). Correlation analysis using Fit Y by X model showed statistically significant differences between CSA (score ≤ 3 and >3) and other variables such as whites vs blacks p <0.001, females vs males p=0.0006, not married vs married p<0.0001, and no family support vs family support p<0.0001. Conclusions: Male, unmarried and black patients were associated with higher CSA. Patients who were white, married and with family support had higher likelihood of enrolling in hospice. [Table: see text]

Equality during end-of-life cancer care: Trends in aggressiveness of cancer care at the end of life.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 77-77
Author(s):  
Praveen Namireddy ◽  
Vicki McLawhorn ◽  
Sweta Jonnalagadda ◽  
Mahvish Muzaffar
Keyword(s):  
End Of Life ◽  
Family Support ◽  
Cancer Care ◽  
Hospice Care ◽  
Hospital Admissions ◽  
Composite Score ◽  
Minority Population ◽  
Icu Admission ◽  
Significant Difference ◽  
Ed Visits

77 Background: Aggressive cancer care at the end of life (EOL) can impact quality of life and have major economic burden. The purpose of this study was to portray the aggressiveness of EOL cancer care, and its relation to race, gender and social factors in Eastern North Carolina with high rural and minority population. Methods: This is a retrospective analysis of 401 stage 4 solid tumor patients who died between 2011 and 2014. Aggressiveness of care was calculated by a composite score adopted from Earle et al. Scores range from 0 to 7 with higher scores indicating more aggressive EOL care. 1 point was given to each indicator of aggressiveness in the last 30 days of life: ED visits ≥2,hospital admissions ≥2,any ICU admission,hospitalized days ≥14,new chemotherapy, hospice care ≤ 3 days, and any chemotherapy in the last 14 days. Results: Among the 401 patients, 217 (54%) were white and 178 (44%) were black. The mean composite score of aggressiveness (CSA) for whites was 1.18 and for blacks it was 1.87. (p<0.001).In the last 30 days of death, a higher proportion of blacks had ≥ 2 ED visits 28% vs 13%(p<.0001), ≥ 2 hospital admission 23% vs 13%(p=0.001), any ICU admission 29% vs 16%(p=0.0002), chemotherapy in the last 14 days 30% vs 20%(p=0.001), ≥ 14 hospitalized days 35% vs 21%(p<0.001), and hospital deaths 46% vs 32%(p=0.001) compared to whites. More whites enrolled in hospice compared to blacks 53% vs 45% (p<0.001). Correlation analysis using Fit Y by X model between CSA (score ≤ 3 and >3) and other variables showed statistically significant difference between whites vs blacks p <0.001, females vs males p=0.0006, not married vs married p<0.0001, and no family support vs family support p<0.0001. Conclusions: Male, unmarried and black patients were associated with higher CSA. Patients who were white, married and with family support had high likelihood of enrolling in hospice. [Table: see text]

Understanding total cost of cancer care to determine strategic interventions to improve value.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 4-4 ◽  
Author(s):  
Kerin B. Adelson ◽  
Salimah Velji ◽  
Kavita Patel ◽  
Basit Chaudhry ◽  
Sonia Grizzle ◽  
...  
Keyword(s):  
End Of Life ◽  
Hospital Admissions ◽  
Academic Medical Center ◽  
Cost Of Care ◽  
Urgent Care ◽  
First Episode ◽  
Cancer Centers ◽  
Total Cost ◽  
Ed Visits ◽  
Infrastructure Investments

3 Background: Cancer centers across the country are largely unprepared to move toward value-based payment. Total cost of care data is not readily available and centers do not know how much of their patients’ care is received at other hospitals, when in the trajectory of illness greatest cost is incurred, or the elements of care that present the greatest opportunity for savings. A previous examination of practice patterns Smilow Cancer Hospital (SCH) demonstrated that our patients had high rates of ED visits, hospital admissions and ICU use in their last month of life. While this data is consistent with other large academic cancer centers (AMCs), there is a clear opportunity to improve our end-of-life planning and reduce futile care. Cost data supplemented the overutilization analysis, informing the infrastructure investments to prepare us for value-based payment models. Methods: We accessed the 5% Medicare Limited Dataset (2012-2013) to map out cost of care in 6-month episodes for all Medicare patients receiving chemotherapy. Patients who had received chemotherapy at a SCH site were flagged and the analysis included all cost of care, regardless of the site of service or type of professional delivering the service. Results: On average, a first episode of care at SCH cost $26,500, a second episode $38,000 and a third $45,600. Our analysis demonstrated important associations between increases in spending and ED utilization. Patients who had 1 or fewer ED visits during an episode, averaged $21,000 vs. $49,000 for those with 2 or more. Patients who died during an episode cost $53,000 compared to $25,600 for patients who lived. SCH episodes were significantly more expensive than CT, and slightly more than a comparable east coast Academic Medical Center. Conclusions: The above demonstrates that aggressive treatments, ED visits and hospital admissions at the end-of-life are major cost drivers. We used the analysis to target infrastructure investments in Urgent Care to reduce ED utilization, Care Management to prevent hospital admissions/readmissions and early referral to Palliative Care for clarification of goals of care. We believe these investments will lead to significant cost reductions.

Patterns and costs of hospital-based cancer care in the last year of life: A national data linkage study in England.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18769-e18769
Author(s):  
Xhyljeta Luta ◽  
Katharina Diernberger ◽  
Joanna Bowden ◽  
Joanne Droney ◽  
Peter S Hall ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Cancer Care ◽  
Hospital Admissions ◽  
Health Care Utilisation ◽  
Cost Of Care ◽  
Hospital Episode Statistics ◽  
Hospital Episode ◽  
Care Utilisation

e18769 Background: Delivery of high quality cancer care is associated with rising costs, both in earlier stages of the illness trajectory and at the end of life. A significant portion of the costs and health care utilisation occurs in the last year of life. Most publications to date have focused on costs in hospital. Little is known about the costs of care for cancer patients across the entire health service. The aim was to examine primary, secondary and acute health care utilisation and cost in the last 12 months of life and how these differ by cancer diagnosis and other patient characteristics among decedent patients aged 60 and over. Methods: We conducted a retrospective cohort study of people aged 60 years and over (N=26,077) who died in England between 2010 and 2017. We used routinely collected and linked data from primary care (Clinical Practice Research Datalink (CPRD) secondary and acute care, (Hospital Episode Statistics (HES), and death data (Office for National Statistics (ONS)). This provided a nationally representative sample of the English population. We analysed of healthcare utilisation and resource use amongst decedents by gender, primary cause of death, age, geography, socio-economic status and comorbidities. Results: Overall, 90.2 % of the cancer decedents were admitted in the hospital at least once in the last 12 months of life. About 50% of patients we admitted to hospital in the last month of life with 37.6 being admitted to the hospital more than once in the last month of life. The health care utilisation and costs increased sharply in the last month of life. life. The mean number of hospital admissions in the last year of life was 3.7 (SD, 5.8). Those dying of haematological cancers (N=2093) had highest number of hospital admissions (mean:7.2, SD:10.8) and longer average hospital stay (mean:36.7, SD:33.0) (mean:12.0, SD:14.4). Use of outpatient services was highest in the group dying of haematological cancers (mean:12.0, SD:14.4) whereas those dying of prostate cancer (N= 2197) had higher number of emergency (mean:2.0, SD: 1.9) and GP visits (mean:30.8, SD: 20.7). Healthcare costs were highest among haematological cancers and lowest among those dying of breast cancer. Proximity to death and comorbidities were the main contributors of end-of-life care health care utilisation and costs. Conclusions: This study uses large linked datasets (linked to the whole spectrum of hospital episode statistics) providing a comprehensive picture of healthcare services accessed by cancer patients at end of life in England. There is significant variation in use and cost of care for cancer patients in the last year and month of life. Further analysis of variation according to hospice, palliative, and social care service provision may identify strategies to address this variation.

Value and use of patient reported outcomes in sarcoma clinic through GetWell Loop app.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 179-179
Author(s):  
Ensi Voshtina ◽  
John A. Charlson
Keyword(s):  
Patient Satisfaction ◽  
High Risk ◽  
Healthcare Provider ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Hospital Admissions ◽  
Phone Call ◽  
Patient Reported ◽  
Ed Visits ◽  
Reported Data

179 Background: Symptom monitoring in cancer care through patient reported outcomes has been used as an approach to improve symptom detection and communication. Through monitoring of patient symptoms via a systematic way, previous studies have shown a reduction in ED visits and hospital admissions, an enhancement in patient-clinician communication and overall patient satisfaction and wellbeing. In this study, we evaluated outcomes of patient reported data by using the GetWell Loop app to help determine if it facilitates cancer care and improves clinical outcomes. Methods: We performed a retrospective, single-center analysis of sarcoma patients age > 18 who between December 2019 to January 2021 received systemic treatment and were enrolled to use GetWell Loop app to report their treatment related outcomes. We asked patients how they are feeling on a systematic basis post treatment by using a series of questions related to their therapy and potential symptoms. Through the use of GetWell Loop, patients are able to record symptoms information and prompt evaluation by a healthcare provider if they report severe or rapidly changing symptoms. Descriptive statistics were used to summarize use of the GetWell Loop through patient surveys, app generated data, and data available in EPIC electronic medical record. We noted the number of yellow (moderate) and red (severe) alerts generated by patient responses and the corresponding alert trigger to health care provider response. Healthcare provider communication and interventions were recorded, as were hospitalizations and ED visits while using the app. Results: A total of 75 patients were invited to join enrollment. Of those, 54 activated the app, with an activation rate of 72%. Engagement rate was 61% and 74 total alerts were generated. Of the severity of symptoms leading to an alert, 28% were red alters and 72% were yellow alerts. Red alerts most commonly comprised of decreased fluid intake, constipation, and fevers. The majority of red alert symptoms lead to an intervention from nursing staff that started with a phone call, while a minority of interventions were in app messages with the patient. Five red alerts led to an ED visit. The majority of yellow alert symptoms were addressed through in app messages. Both clinical staff and patients felt it helped them stay connected. Patients were most adherent with the first treatment. Patient satisfaction was 87.5% with the app usage. Conclusions: Using patient reported outcomes by using the GetWell Loop app yielded an overall positive patient experience. It provides an opportunity to intervene early with high risk patients and prevent ED visits. Focusing on the first cycle of a regiment and subsequent cycles if high risk seemed to provide the most benefit. There is utility to expand to other disease teams and use the app for survivorship support as well.

Preference of place for end-of-life cancer care and death among bereaved Japanese families who experienced home hospice care and death of a loved one

2009 ◽  
Vol 18 (11) ◽  
pp. 1445-1453 ◽  
Author(s):  
JiEun Choi ◽  
Mitsunori Miyashita ◽  
Kei Hirai ◽  
Kazuki Sato ◽  
Tatsuya Morita ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Care ◽  
Hospice Care ◽  
Loved One ◽  
Home Hospice Care

Patterns of End-of-Life Care as Measured by Emergency Room Visits Among Cancer Patients in Puerto Rico

2021 ◽  
pp. 104990912110257
Author(s):  
María R. Ramos-Fernández ◽  
Karen J. Ortiz-Ortiz ◽  
Carlos R. Torres-Cintrón ◽  
Guillermo Tortolero-Luna
Keyword(s):  
Puerto Rico ◽  
End Of Life ◽  
Cancer Patients ◽  
Hospice Care ◽  
Poor Quality ◽  
P Value ◽  
Study Cohort ◽  
Quality Cancer Care ◽  
Ed Visits ◽  
Adjusted Model

Background: Community palliative care (PC) services are scarce in Puerto Rico (PR). Patients with advanced cancer commonly visit the emergency department(ED) at the end of life (EoL). Recognition of patients with limited life expectancies and PC needs may improve the EoL trajectory of these patients. Our objective was to characterize ED visits of cancer patients at the EoL by examining the patterns of ED visits in PR using the PR Central Cancer Registry-Health Insurance Linkage Database (PRCCR-HILD). Methods: The cohort consisted of patients aged ≥18 years with a primary invasive that died between 2011- 2017, with a recorded date of death, and who had insurance claims during their last three months. EoL indicators were ED visits, ED death, and hospice care use. Results: The study cohort included 10,755 cancer patients. 49.6% had ≥1 ED visit, 20.3% had ≥2 ED visits, and 9.7% died in the ED. In the adjusted model, female patients (aOR 0.80; 95% CI 0.68-0.93; p-value < 0.01), patients aged ≥80 years (aOR 0.47; 95% CI 0.36-0.63; p-value < 0.01), being enrolled in Medicare (aOR 0.74; 95% CI 0.61-0.90; p-value < 0.01) or being enrolled in Medicaid/Medicare (aOR 0.76; 95% CI 0.62-0.93; p-value = 0.01) were less likely to have an ED visit the date of death. Patients with distant stage are more likely to have ED ≥ 2visits ( p-value < 0.05). Conclusions: ED visits at EoL can be interpreted as poor quality cancer care and awareness of the potential of ED-initiated PC is needed in PR.

Examining the Association of Billed Advance Care Planning With End-of-Life Hospital Admissions Among Advanced Cancer Patients in Hospice

2021 ◽  
pp. 104990912110394
Author(s):  
Laura C. Prater ◽  
Brian O’Rourke ◽  
Patrick Schnell ◽  
Wendy Xu ◽  
Yiting Li ◽  
...  
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Hospice Care ◽  
Hospital Admissions ◽  
Care Planning ◽  
Advanced Cancer Patients ◽  
Cross Sectional ◽  
Hospice Referral ◽  
Advance Care

Background: Advance care planning (ACP), or the consideration and communication of care preferences for the end-of-life (EOL), is a critical process for improving quality of care for patients with advanced cancer. The incorporation of billed service codes for ACP allows for new inquiries on the association between systematic ACP and improved EOL outcomes. Objective: Using the IBM MarketScan® Database, we conducted a retrospective medical claims analysis for patients with an advanced cancer diagnosis and referral to hospice between January 2016 and December 2017. We evaluated the association between billed ACP services and EOL hospital admissions in the final 30 days of life. Design: This is a cross-sectional retrospective cohort study. Participants: A total of 3,705 patients met the study criteria. Main Measures: ACP was measured via the presence of a billed ACP encounter (codes 99497 and 99498) prior to the last 30 days of life; hospital admissions included a dichotomous indicator for inpatient admission in the final 30 days of life. Key Results: Controlling for key covariates, patients who received billed ACP were less likely to experience inpatient hospital admissions in the final 30 days of life compared to those not receiving billed ACP (OR: 0.34; p < 0.001). Conclusion: The receipt of a billed ACP encounter is associated with reduced EOL hospital admissions in a population of patients with advanced cancer on hospice care. Strategies for consistent, anticipatory delivery of billable ACP services prior to hospice referral may prevent potentially undesired late-life hospital admissions.

Implementation of an interdisciplinary care team to create individualized care plans for high risk oncology patients: A model to decrease aggressiveness of care at the end of life and improve cost effectiveness of care.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 171-171
Author(s):  
Girish Chandra Kunapareddy ◽  
Joseph Hooley ◽  
Leticia Varella ◽  
Christa Poole ◽  
Helen Tackitt ◽  
...  
Keyword(s):  
Length Of Stay ◽  
End Of Life ◽  
Hospice Care ◽  
Care Team ◽  
Interdisciplinary Care ◽  
Oncology Patients ◽  
Time To Death ◽  
Care Plans ◽  
Individualized Care ◽  
Ed Visits

171 Background: Due to complexity of disease and treatments, oncology patients have among the highest hospitalization rate, especially towards End of Life (EOL). In our cancer institute, just 6% of all discharged patients accounted for >40% of unplanned readmissions, and continue to be highest risk of future admissions, ICU stay, ED visits, overuse of chemotherapy and under use of hospice care. We hypothesized that developing individualized care plans (ICP) for this high-utilization group will provide guidance in the complex care they require to reduce unnecessary and aggressive medical services. Methods: An Interdisciplinary Care Team (ICT) was created consisting of palliative medicine and oncology physicians, social workers, care coordinators, and nurses. On a bimonthly basis, patients with at least two unplanned hospital readmissions over the last 60 days were identified. ICPs were created using a team-based approach with parallel input from patient’s primary outpatient providers. Results: A total of 36 patients, 226 hospitalizations, and 163 ED visits were evaluated over a 6-month period, with an average number of hospitalizations of 1.08 per patient month (ppm). After implementation of ICP, hospitalizations decreased to 0.23 ppm, with an average length of stay decrease from 7.17 to 4.06 days per admission. Average ED visits decreased from 0.58 to 0.34 ppm, and the average number of unplanned readmissions decreased from 0.43 to 0.13 ppm. Of the 10 patients expired since creation of ICP, 8 utilized hospice care, while 2 patients died in an ICU. Average time to death from creation of ICP was 72 days among this cohort, while time to death from last exposure to chemotherapy was 58 days. Conclusions: Creation of individualized care plans for high-utilizing cancer patients decreased number of hospitalizations, ED visits, unplanned readmissions, and length of stay. A dedicated focus from a team of experts, beyond disease biology, on a unique patient situation may result in improved patient experience with decreased aggressiveness of care at EOL and overall resource utilization.

End-of-life palliative care resource utilization in cancer care: A focus on the urban-rural continuum.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 52-52
Author(s):  
Jessica Cerni ◽  
Joel Rhee ◽  
Hassan Hosseinzadeh
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Care ◽  
Service Use ◽  
Inclusion Criteria ◽  
Care Services ◽  
Quantitative Studies ◽  
Palliative Care Services ◽  
Urban Rural ◽  
Ed Visits

52 Background: Despite the advances in end-of-life cancer care, disparities exist in the availability, accessibility and use of palliative care services across the urban-rural continuum. This review explores this disparity by synthesising retrospective quantitative studies on palliative care patterns of resource use for adults during end-of-life cancer care. Methods: Five databases were searched and data analysed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria involved; a) original research; b) quantitative studies; c) English-language; d) study assessed palliative care related service use in adult (18yrs+) cancer patients with any malignancy excluding non-melanoma skin cancer; e) exclusive end of life focus and f) urban-rural focus. Narrative reviews and discussions were excluded. Results: After reviewing all titles and abstracts ( N= 816) and full text review ( N= 163) 44 studies met the inclusion criteria and were included in the analysis. End-of-life palliative care access and utilisation patterns varied across the geographical urban-rural continuum. Geographical region of residence had the strongest association with multiple ED visits and hospitalizations in rural or remote areas. Most common palliative care services used within the last 30 days of death were ED visits and hospital admissions. Two studies assessed palliative radiotherapy and one study assessed palliative care pharmacotherapy. The odds of palliative service use were lowest for males and individuals with a survival diagnosis (0-3months). The largest inequities were explained by individual level factors including gender as assessed in ( N= 44 studies), socioeconomic status ( N= 15), proximity to service ( N= 10) and survival time from cancer diagnosis ( N= 9). Conclusions: Rurality was an important predictor for poorer outcomes in the quality of end-of-life cancer care. Findings suggest that addressing the urban-rural continuum is critical for equitable, timely and efficient palliative cancer care. Further research is required to understand barriers to service usage to achieve optimal palliative care.

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