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Abe M, Tsunawaki S, Dejonckheere M, Cigolle CT, Phillips K, Rubinstein EB, Matsuda M, Fetters MD, Inoue M. Practices and perspectives of primary care physicians in Japan and the United States about diagnosing dementia: a qualitative study. BMC Geriatr 2021; 21:540. [PMID: 34635089 PMCID: PMC8503990 DOI: 10.1186/s12877-021-02457-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background While dementia is a common problem in Japan and the US, primary care physicians' practices and perspectives about diagnosing dementia in these different healthcare systems are unknown. Methods Qualitative research was conducted in an ethnographic tradition using semi-structured interviews and thematic analysis in primary care settings across Japan and in the Midwest State of Michigan, US. Participants were a total of 48 primary care physicians, 24 each from Japan and the US participated. Both groups contained a mixture of geographic areas (rural/urban), gender, age, and years of experience as primary care physicians. Results Participants in Japan and the US voiced similar practices for making the diagnosis of dementia and held similar views about the desired benefits of diagnosing dementia. Differences were found in attitudes about the appropriate timing of formally diagnosing dementia. Japanese physicians tended to make a formal diagnosis when problems that would benefit from long-term care services emerged for family members. US physicians were more proactive in diagnosing dementia in the early stages by screening for dementia in health check-ups and promoting advance directives when the patients were still capable of decision-making. Views about appropriate timing of diagnostic testing for dementia in the two systems reflect what medical or nursing care services physicians can use to support dementia patients and caregivers. Conclusions Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US. Testing to establish an early diagnosis of dementia by primary care physicians only partly relates to testing and treatment options available. Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02457-7.
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Affiliation(s)
- M Abe
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Shizuoka, Hamamatsu, Japan
| | - S Tsunawaki
- Omaezaki Family Medicine Center, Shizuoka, Omaezaki, Japan.,Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan
| | - M Dejonckheere
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA
| | - C T Cigolle
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System (VAAHS) Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA
| | - K Phillips
- VA Ann Arbor Healthcare System (VAAHS) Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA
| | - E B Rubinstein
- Department of Sociology and Anthropology, North Dakota State University, Fargo, North Dakota, USA
| | - M Matsuda
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan.,Kikugawa Family Medicine Center, Shizuoka, Kikugawa, Japan
| | - M D Fetters
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA. .,The School of Health Humanities, Peking University Health Science Center, Beijing, China.
| | - M Inoue
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Shizuoka, Hamamatsu, Japan
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Daubman BR, Bernacki R, Stoltenberg M, Wilson E, Jacobsen J. Best Practices for Teaching Clinicians to Use a Serious Illness Conversation Guide. Palliat Med Rep 2020; 1:135-142. [PMID: 34223467 PMCID: PMC8241361 DOI: 10.1089/pmr.2020.0066] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 01/05/2023] Open
Abstract
With the palliative care workforce shortage and changes in advance care planning reimbursement, many institutions are requesting that palliative care specialists provide serious illness communication training across their institution's workforce. Based on our experience training clinicians to use the Partners Serious Illness Conversation Guide, a structured guide to teach basic palliative care communication skills, we propose a set of best practices to help others teach use of a communication guide at their institution, including fostering a safe learning environment, explicit teaching of structured communication, and preparing cofacilitators to adapt to differing skill levels of learners.
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Affiliation(s)
- Bethany-Rose Daubman
- Division of Palliative Care and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Rachelle Bernacki
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA.,Ariadne Labs, Harvard School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark Stoltenberg
- Division of Palliative Care and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Erica Wilson
- Division of Palliative Care and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Juliet Jacobsen
- Division of Palliative Care and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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3
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Gazarian PK, Cronin J, Baker KM, Friel BJ. Patient and nurse perspectives on advance care planning in acute care. Appl Nurs Res 2019; 50:151203. [PMID: 31677930 DOI: 10.1016/j.apnr.2019.151203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/06/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Priscilla K Gazarian
- University of Massachusetts Boston, College of Nursing and Health Sciences, 100 William T. Morrissey Blvd., Boston, MA 02125-3393, United States.
| | - Julie Cronin
- University of Massachusetts Boston, College of Nursing and Health Sciences, 100 William T. Morrissey Blvd., Boston, MA 02125-3393, United States.
| | - Kayla M Baker
- University of Massachusetts Boston, College of Nursing and Health Sciences, 100 William T. Morrissey Blvd., Boston, MA 02125-3393, United States.
| | - Barbara J Friel
- University of Massachusetts Boston, College of Nursing and Health Sciences, 100 William T. Morrissey Blvd., Boston, MA 02125-3393, United States.
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Ruiz S, Snyder LP, Giuriceo K, Lynn J, Ewald E, Branand B, Parashuram S, Loganathan S, Bysshe T. Innovative Models for High-Risk Patients Use Care Coordination and Palliative Supports to Reduce End-of-life Utilization and Spending. Innov Aging 2017; 1:igx021. [PMID: 30480116 PMCID: PMC6176974 DOI: 10.1093/geroni/igx021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives Care coordination and palliative care supports are associated with reduced anxiety, fewer hospital admissions, and improved quality of life for patients and their families. Early palliative care can result in savings in the end-of-life period, but there is limited evidence that larger-scale models can improve both utilization and the cost of care. Three models that received Health Care Innovation Awards from the Centers for Medicare & Medicaid Services aimed to improve quality of care and reduce cost through the use of innovative care coordination models. This study explores the total cost of care and selected utilization outcomes at the end-of-life for these innovative models, each of which enrolled adults with multiple chronic conditions and featured care coordination with advance care planning as a component of palliative care. These included a comprehensive at-home supportive care model for persons predicted to die within a year and two models offering advance care planning in nursing facilities and during care transitions. Research Design and Methods We used regression models to assess model impacts on costs and utilization for high-risk Medicare beneficiaries participating in the comprehensive supportive care model (N = 3,339) and the two care transition models (N = 587 and N = 277) who died during the study period (2013-2016), relative to a set of matched comparison patients. Results Comparing participants in each model who died during the study period to matched comparators, two of the three models were associated with significantly lower costs in the last 90 days of life ($2,122 and $4,606 per person), and the third model showed nonsignificant differences. Two of the three models encouraged early hospice entry in the last 30 days of life. For the comprehensive at-home supportive care model, we observed aggregate savings of nearly $19 million over the study period. One care transition model showed aggregate savings of over $500,000 during the same period. Potential drivers of these cost savings include improved patient safety, timeliness of care, and caregiver support. Discussion and Implications Two of the three models achieved significant lower Medicare costs than a comparison group and the same two models also sustained their models beyond the Centers for Medicare & Medicaid Services award period. These findings show promise for achieving palliative care goals as part of care coordination innovation.
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Affiliation(s)
- Sarah Ruiz
- National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, Washington, District of Columbia
| | - Lynne Page Snyder
- NORC at the University of Chicago, Health Care Department, Bethesda, Maryland
| | - Katherine Giuriceo
- Center for Medicare and Medicaid Innovation (CMMI), Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | - Joanne Lynn
- Center for Elder Care and Advanced Illness, Altarum Institute, Washington, District of Columbia
| | - Erin Ewald
- NORC at the University of Chicago, Health Care Department, Bethesda, Maryland
| | - Brittany Branand
- NORC at the University of Chicago, Health Care Department, Bethesda, Maryland
| | - Shriram Parashuram
- NORC at the University of Chicago, Health Care Department, Bethesda, Maryland
| | - Sai Loganathan
- NORC at the University of Chicago, Health Care Department, Bethesda, Maryland
| | - Tyler Bysshe
- NORC at the University of Chicago, Health Care Department, Bethesda, Maryland
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5
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Abbott J. Understanding What People Intend: Is It Possible From Written Advance Directives? J Am Med Dir Assoc 2017; 18:10-11. [DOI: 10.1016/j.jamda.2016.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 10/31/2016] [Indexed: 12/01/2022]
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