scholarly journals Models of Outpatient Palliative Care Clinics for Patients With Cancer

2019 ◽  
Vol 15 (4) ◽  
pp. 187-193 ◽  
Author(s):  
Esme Finlay ◽  
Kristina Newport ◽  
Shanthi Sivendran ◽  
Laurel Kilpatrick ◽  
Michelle Owens ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Safety Net ◽  
Cancer Center ◽  
Patients With Cancer ◽  
Safety Net Hospital

PURPOSE: Early integration of outpatient palliative care (OPC) benefits patients with advanced cancer and also the health care systems in which these patients are seen. Successful development and implementation of models of OPC require attention to the needs and values of both the patients being served and the institution providing service. SUMMARY: In the 2016 clinical guideline, ASCO recommended integrating palliative care early in the disease trajectory alongside cancer-directed treatment. Despite strong endorsement and robust evidence of benefit, many patients with cancer lack access to OPC. Here we define different models of care delivery in four successful palliative care clinics in four distinct health care settings: an academic medical center, a safety net hospital, a community health system, and a hospice-staffed clinic embedded in a community cancer center. The description of each clinic includes details on setting, staffing, volume, policies, and processes. CONCLUSION: The development of robust and capable OPC clinics is necessary to meet the growing demand for these services among patients with advanced cancer. This summary of key aspects of functional OPC clinics will enable health care institutions to evaluate their specific needs and develop programs that will be successful within the environment of an individual institution.

Tobacco use, knowledge of harms, and cessation support among patients with non-tobacco related cancers.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24029-e24029
Author(s):  
Laura Vater ◽  
Anup Trikannad Ashwini Kumar ◽  
Neha Sehgal ◽  
Maria Khan ◽  
Kelsey Bullens ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Treatment ◽  
Medical Center ◽  
Safety Net ◽  
Cancer Center ◽  
Prescribe Medication ◽  
Patients With Cancer ◽  
Quit Smoking ◽  
Increased Risk ◽  
Quit Attempts

e24029 Background: Continued cigarette smoking among patients with cancer leads to numerous adverse health outcomes, even among patients with non-tobacco-related cancers such as breast, colon, and prostate cancer. Continued smoking is associated with poorer response to cancer treatment, increased risk for treatment-related toxicities, and shorter overall survival. While some patients with a smoking-related cancer make efforts to quit smoking at the time of diagnosis, patients with other forms of cancer might not understand the negative effects of continued smoking. In this study, we assessed patient knowledge of the harms of continued smoking, previous cessation attempts, and cessation support. Methods: We surveyed 102 adults with breast, colon, and prostate cancer at three locations: an NCI-designated cancer center, an urban safety-net medical center, and a rural cancer center. Patients were asked about current smoking behaviors, beliefs about the harms of continued smoking, quit attempts and resources used, and cessation support. We also surveyed seven oncologists to assess beliefs about harms of continued smoking, cessation support provided to patients, training and confidence in cessation counseling, and barriers to providing cessation support. Results: Most patients (82%) agreed or strongly agreed that continued smoking may shorten life expectancy, and 70% agreed or strongly agreed that continued smoking increased the risk of getting a different type of cancer. Only 41% of patients agreed or strongly agreed that continued smoking may cause more side effects from cancer treatment, and only 40% agreed or strongly agreed that ongoing smoking may affect treatment response. The majority of patients (86%) had tried to quit smoking for good, with an average 4.1 quit attempts per patient. Patients reported that physicians advised them to quit the majority of the time (92%), prescribed medication 33% of the time, and followed up on cessation attempts 43% of the time. Overall, oncologists had higher knowledge of the harms of continued smoking on treatment outcomes and survival. Those in practice for 20 years or more had higher confidence in cessation counseling than those in practice less than 4 years. Oncologists described lack of time and lack of confidence in cessation counseling as barriers to providing more cessation support. Conclusions: Among 102 patients with breast, colon, and prostate cancer who currently smoke, there was incomplete knowledge of the harms of continued smoking. Oncologists believe that tobacco cessation is important and frequently advise patients to quit, however they less frequently prescribe medication or follow up on cessation efforts. Interventions are needed to educate patients with cancer about the harms of continued smoking and to provide further cessation support.

Prior Frequent Emergency Department Use as a Predictor of Emergency Department Visits After a New Cancer Diagnosis

2021 ◽  
pp. OP.20.00889
Author(s):  
Arthur S. Hong ◽  
Danh Q. Nguyen ◽  
Simon Craddock Lee ◽  
D. Mark Courtney ◽  
John W. Sweetenham ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Diagnosis ◽  
Negative Binomial ◽  
Academic Medical Center ◽  
Safety Net ◽  
Emergency Department Visits ◽  
Patients With Cancer ◽  
Safety Net Hospital ◽  
Ed Visits ◽  
After Cancer

PURPOSE: To determine whether emergency department (ED) visit history prior to cancer diagnosis is associated with ED visit volume after cancer diagnosis. METHODS: This was a retrospective cohort study of adults (≥ 18 years) with an incident cancer diagnosis (excluding nonmelanoma skin cancers or leukemia) at an academic medical center between 2008 and 2018 and a safety-net hospital between 2012 and 2016. Our primary outcome was the number of ED visits in the first 6 months after cancer diagnosis, modeled using a multivariable negative binomial regression accounting for ED visit history in the 6-12 months preceding cancer diagnosis, electronic health record proxy social determinants of health, and clinical cancer-related characteristics. RESULTS: Among 35,090 patients with cancer (49% female and 50% non-White), 57% had ≥ 1 ED visit in the 6 months immediately following cancer diagnosis and 20% had ≥ 1 ED visit in the 6-12 months prior to cancer diagnosis. The strongest predictor of postdiagnosis ED visits was frequent (≥ 4) prediagnosis ED visits (adjusted incidence rate ratio [aIRR]: 3.68; 95% CI, 3.36 to 4.02). Other covariates associated with greater postdiagnosis ED use included having 1-3 prediagnosis ED visits (aIRR: 1.32; 95% CI, 1.28 to 1.36), Hispanic (aIRR: 1.12; 95% CI, 1.07 to 1.17) and Black (aIRR: 1.21; 95% CI, 1.17 to 1.25) race, homelessness (aIRR: 1.95; 95% CI, 1.73 to 2.20), advanced-stage cancer (aIRR: 1.30; 95% CI, 1.26 to 1.35), and treatment regimens including chemotherapy (aIRR: 1.44; 95% CI, 1.40 to 1.48). CONCLUSION: The strongest independent predictor for ED use after a new cancer diagnosis was frequent ED visits before cancer diagnosis. Efforts to reduce potentially avoidable ED visits among patients with cancer should consider educational initiatives that target heavy prior ED users and offer them alternative ways to seek urgent medical care.

scholarly journals Rapid Implementation of Video Visits in Neurology During COVID-19: Mixed Methods Evaluation (Preprint)

2020 ◽  
Author(s):  
Erika A Saliba-Gustafsson ◽  
Rebecca Miller-Kuhlmann ◽  
Samantha M R Kling ◽  
Donn W Garvert ◽  
Cati G Brown-Johnson ◽  
...  
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Care Delivery ◽  
Medical Center ◽  
Health Care Systems ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Traditional Health ◽  
Traditional Health Care ◽  
Care Systems

BACKGROUND Telemedicine has been used for decades. Despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology’s ambulatory subspecialties has been sparse. However, the COVID-19 pandemic prompted health care systems worldwide to reconsider traditional health care delivery. To safeguard health care workers and patients, many health care systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care. OBJECTIVE To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess adoption, acceptability, appropriateness, and perceptions of potential sustainability. METHODS Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semistructured interviews with providers (n=30) completed between March and May 2020. RESULTS Video visits were adopted rapidly; overall, 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted their satisfaction. Video visits were reported to be more convenient for patients, families, and caregivers than in-person visits; however, access to technology, the patient’s technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination. CONCLUSIONS Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike.

Knowledge, Beliefs, and Behaviors Related to Palliative Care Delivery Among Pediatric Oncology Health Care Providers

2018 ◽  
Vol 35 (4) ◽  
pp. 247-256 ◽  
Author(s):  
Jessica L. Spruit ◽  
Cynthia J. Bell ◽  
Valerie B. Toly ◽  
Maryjo Prince-Paul
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Pediatric Oncology ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Advanced Practice ◽  
Care Providers ◽  
The Public ◽  
Patients With Cancer

The care of pediatric patients with cancer and their families is complex and rapidly evolving. Despite significant advances in outcomes, symptoms of the disease and complications of therapy continue to cause suffering that may improve with the involvement of pediatric palliative care (PPC) services. This descriptive study responds to the observation of great variability in PPC utilization within pediatric oncology. Data collected from 156 health care professionals (nurses, advanced practice professionals, and physicians) from a statewide hematology alliance evaluates the knowledge, beliefs, and perceived barriers to PPC involvement. Data analysis reveals significant variability when comparing respondents from professional roles and practice environments. Despite progress in PPC availability, care delivery remains incongruent with current recommendations. Knowledge gained from this study emphasizes the important role for all health care providers in advocating for support of PPC programs, educating the public, and committing to intentional involvement of PPC services while caring for pediatric oncology patients.

Themes of Worry Among Psychiatric Inpatients That Persist Through Acute Hospitalization

2020 ◽  
pp. 107839032097376
Author(s):  
Pia Engstrom ◽  
Matthew Bolton ◽  
Cynthia Bautista ◽  
Todd Barnes
Keyword(s):  
Quality Improvement ◽  
Behavioral Health ◽  
Medical Center ◽  
Academic Medical Center ◽  
Psychiatric Inpatient ◽  
Safety Net ◽  
Health Staff ◽  
Improvement Project ◽  
Safety Net Hospital ◽  
Psychiatric Units

INTRODUCTION Problems that worry patients throughout hospitalization are complex and varied, but they fall within the scope of safe, effective, patient-centered care. To our knowledge, there is no evidence describing the problems that worry patients in inpatient psychiatric units. AIM The purpose of this quality improvement project was to describe common themes of worry experienced by individuals in psychiatric inpatient units in order to improve patient experience. METHOD This project took place at an urban, safety net hospital at an academic medical center in the northeastern United States between March and December 2019. All patients across five inpatient psychiatric units were offered the Combined Assessment of Psychiatric Environments (CAPE) survey as they approached the end of their stay. RESULTS A total of 1,800 patients took the survey. Of these patients, 36% (650/1,800) patients responded never/sometimes to “During my hospitalization, I found solutions to problems that worried me,” and 46% (297/650) patients provided a response to the follow-up question “What are the problems that worry you the most?” Common themes of worry for inpatient behavioral health patients include (a) life in the hospital, (b) self, and (c) outside life. CONCLUSION Each of these worry themes that emerged from this thematic analysis has implications for behavioral health staff who are preparing the psychiatric/behavioral health inpatient for discharge. These themes can also be used to focus on a variety of quality improvement initiatives to improve the patients experience while in an inpatient psychiatric/behavioral health unit.

scholarly journals The Impact of Payer Status on Hospital Admissions: Evidence from an Academic Medical Center

2021 ◽  
Author(s):  
Yanying Zhao ◽  
Ioannis Ch. Paschalidis ◽  
Jianqiang Hu
Keyword(s):  
Access To Care ◽  
Low Income ◽  
Hospital Admissions ◽  
Medical Center ◽  
Conditional Logistic Regression ◽  
Private Insurance ◽  
Academic Medical Center ◽  
Safety Net ◽  
Safety Net Hospital ◽  
The Impact

Abstract Background: Inequity exists in accessing to care for patients with different payer statuses. However, there are few studies on the difference of hospital admissions. This study aims to examine how the payer status affects patients hospitalization from the perspective of a safety-net hospital. Methods: We extracted all patients with visiting record in this medical center between 5/1/2009-4/30/2014, and then linked the outpatient and inpatient records three year before target admission time to patients. We conduct a retrospective observational study using a conditional logistic regression methodology. To control the illness of patients with different diseases in training the model, we construct a three-dimension variable with data stratification technology. The model is validated on a dataset distinct from the one used for training. Results: Payer status is strongly associated with a patient’s admission. Patients covered by private insurance or uninsured are less likely to be admitted than those totally or partially insured by government. For uninsured patients, inequity in access to hospitalization is observed. Among all non-clinical influential factors considered in our study, payer status is a significant important factor. Conclusion: Attention is needed on improving the access to care for vulnerable (low-income) patients, for example, by actively advertising free care programs, reaching out to community organizations with better access to these individuals, or offering assurances that access to care is not linked to immigration procedures. Also, in order to reduce preventable admissions, basic preventive care services should be enhanced.

scholarly journals Implementation of a cloud-based electronic patient-reported outcome (ePRO) platform in patients with advanced cancer

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Olga Generalova ◽  
Mohana Roy ◽  
Evan Hall ◽  
Sumit A. Shah ◽  
Kristen Cunanan ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Supportive Care ◽  
Healthcare Utilization ◽  
Advanced Cancer ◽  
Data Privacy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Ease Of Use ◽  
Cancer Center ◽  
Patient Reported

Abstract Background Patient reported outcomes (PROs) have been associated with improved symptom management and quality of life in patients with cancer. However, the implementation of PROs in an academic clinical practice has not been thoroughly described. Here we report on the execution, feasibility and healthcare utilization outcomes of an electronic PRO (ePRO) application for cancer patients at an academic medical center. Methods We conducted a randomized trial comparing an experimental ePRO arm to standard of care in patients with advanced cancer in the thoracic, gastrointestinal, and genitourinary oncology groups at Stanford Cancer Center from March 2018 to November 2019. We describe the pre-implementation, implementation, and post-implementation phases of the ePRO arm, technological barriers, electronic health record (EHR) integration, clinician burden, and patient data privacy and security. Feasibility was pre-specified to be at least 70% completion of all questionnaires. Acceptability was based on patient and clinician feedback. Ambulatory healthcare utilization was assessed by reviewing numbers of phone messages, electronic portal messages, and referrals for supportive care. Results Of 617 ePRO questionnaires sent to 72 patients, 445 (72%) were completed. Most clinicians (87.5%) and patients (93%) felt neutral or positive about the ePRO tool’s ease of use. Exposure to ePRO did not cause a measurable change in ambulatory healthcare utilization, with a median of less than two phone messages and supportive care referrals, and 5–6 portal messages. Conclusions Web-based ePRO tools for patients with advanced cancer are feasible and acceptable without increasing clinical burden. Key lessons include the importance of pilot testing, engagement of stakeholders at all levels, and the need for customization by disease group. Future directions for this work include completion of EHR integration, expansion to other centers, and development of integrated workflows for routine clinical practice.

The Changing Health Care Environment: Implications for Residency Training

PEDIATRICS ◽  
1998 ◽  
Vol 101 (Supplement_3) ◽  
pp. 795-804 ◽  
Author(s):  
Seth Frazier ◽  
Daniel Hyman ◽  
Steven Altschuler
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Delivery System ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Pediatric Care ◽  
Health Care Environment ◽  
The Impact

Throughout the United States, the growth of managed care is forcing pediatric providers (physicians and hospitals) to reconstruct and integrate the health care delivery system with a focus away from the academic center and toward the community. Managed care also is forcing new financing approaches geared toward the assumption of economic risk for patient management and utilization of services. Radical changes in pediatric training programs will be necessary to accommodate the strategic and operational changes being pursued in response to these evolving market forces. These changes, while disruptive, will strengthen the breadth and diversity of graduate medical education and will better prepare trainees for the new delivery system in which they will practice. In this article, we examine how the evolution of managed care is redefining the basic financial and organizational framework for pediatric care and the implications of this redefinition for children's hospitals and academic medical center-based pediatric programs. We draw on our experience in the greater Philadelphia market to illustrate the impact of these changes and discuss one pediatric system's response. Finally, we review the educational opportunities provided by these changes.

Interdisciplinary Palliative Care Teams

2019 ◽  
pp. 89-97
Author(s):  
Polly Mazanec ◽  
Rebekah Reimer ◽  
Jessica Bullington ◽  
Patrick J. Coyne ◽  
Herman Harris ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interdisciplinary Team ◽  
Palliative Care Team ◽  
Care Team ◽  
Patient Centered ◽  
Team Members ◽  
Palliative Care Teams

This chapter defines the composition and roles of interdisciplinary team members on a palliative care team. The team has the responsibility to deliver patient-centered, family-focused care based on the recommendations from the National Consensus Project Guidelines for Quality Palliative Care. Within this chapter, interdisciplinary team members from an academic medical center discuss their respective roles on the team and describe how these roles supported a patient and family case study. The chapter provides an overview of the four most common models of palliative care delivery: inpatient consult teams, with or without a palliative care unit; ambulatory palliative care teams; community-based palliative care teams; and hospice teams. An introduction to essential considerations in the development of a palliative care team and the important components for maintaining a healthy, functional team are described.

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