1
|
Yoon S, Goh H, Yeo ZZ, Yang GM, Chong PH, Zhuang Q. Comparing situational influences on differential healthcare utilization trajectories in patients on home palliative care: A qualitative study. Palliat Support Care 2024:1-8. [PMID: 38299377 DOI: 10.1017/s1478951524000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Patients with terminal cancer receiving home palliative care present differential healthcare utilization trajectories before death. It remains unclear which situational elements influence these trajectories among disparate patient groups. The aim of this study was to compare situational influences on "persistently high" and "low stable" trajectories of healthcare utilization in patients who received palliative care support at home. METHODS Bereaved family caregivers were recruited from our prior quantitative study investigating healthcare utilization trajectories in oncology patients on home-based palliative care. In-depth interviews were conducted with 30 family caregivers. Data were analyzed using thematic analysis. RESULTS Analysis of data uncovered how the 2 utilization trajectories were influenced by the interplay of 1 or more of 4 situational elements. Perceived symptom control in patients, influenced by their determination to die at home, shapes the susceptibility to situational contingencies, resulting in differential utilization trajectories. Caregivers' mental readiness in dealing with unexpected circumstances has a significant impact on the overall manageability of care, ultimately affecting decisions related to healthcare utilization. The concordance between symptom needs and scope of homecare services in a given situation proves to be an important determinant. Lastly, perceived accessibility to informal support in times of need acts as a contextual reinforcement, either preventing or precipitating decisions regarding healthcare utilizations. SIGNIFICANCE OF RESULTS Our findings hold important implications for the provision of homecare services, in particular, the need for comprehensive assessment of end-of-life wishes during homecare enrolment and strengthening psychological preparedness of caregivers. Expansion of home-based clinical interventions tailored to high utilizers, and funding for temporary in-home respite should be considered to optimally manage potentially preventable acute healthcare utilization.
Collapse
Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, SingHealth, Singapore, Singapore
| | - Hendra Goh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | | - Grace Meijuan Yang
- Division of Supportive & Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Qingyuan Zhuang
- Division of Supportive & Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| |
Collapse
|
2
|
Julià-Móra JM, Blanco-Mavillard I, Prieto-Alomar A, Márquez-Villaverde E, Terrassa-Solé M, Leiva-Santos JP, Rodríguez-Calero MÁ. Analysis of palliative care needs in hospitalized patients. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:261-268. [PMID: 37419323 DOI: 10.1016/j.enfcle.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/16/2023] [Indexed: 07/09/2023]
Abstract
AIM To determine the prevalence of palliative care needs in patients in an acute care hospital and to analyze the profile of these patients. DESIGN We conducted a prospective cross-sectional study in an acute care hospital, in April 2018. The study population consisted of all patients over 18 years of age admitted to hospital wards and intensive care units. Variables were collected on a single day by six micro-teams using the NECPAL CCOMS-ICO© instrument. The descriptive analysis, on patient mortality and length of stay, was performed at a one-month follow-up. RESULTS We assessed 153 patients, of whom 65 (42.5%) were female, with a mean age of 68.17±17.03 years. A total of 45 patients (29.4%) were found to be SQ+, of which 42 were NECPAL+ (27.5%), with a mean age of 76.64±12.70 years. According to the disease indicators, 33.35% had cancer, 28.6% had heart disease, and 19% had COPD, resulting in a ratio of 1:3 between patients with cancer and non-cancer disease. Half of the inpatients in need of palliative care were in the Internal Medicine Unit. CONCLUSIONS Almost 28% of patients were identified as NECPAL+, most of them not identified as under palliative care in clinical records. Greater awareness and knowledge from healthcare professionals would facilitate the early identification of these patients and avoid overlooking palliative care needs.
Collapse
Affiliation(s)
- Joana Maria Julià-Móra
- Equipo de Soporte de Cuidados Paliativos, Hospital de Manacor, Manacor, Spain; Grupo de investigación en Cuidados, Cronicidad y Evidencias en Salud (CurES), Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| | - Ian Blanco-Mavillard
- Unidad de Calidad, Docencia e Investigación, Hospital de Manacor, Manacor, Spain.
| | | | | | | | | | - Miguel Ángel Rodríguez-Calero
- Departamento de Calidad, Hospital Torrecárdenas, Almería, Spain; Departamento de Enfermería y Fisioterapia, Universidad de las Islas Baleares, Palma, Spain; Grupo de investigación en Cuidados, Cronicidad y Evidencias en Salud (CurES), Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| |
Collapse
|
3
|
Zhuang Q, Chong PH, Ong WS, Yeo ZZ, Foo CQZ, Yap SY, Lee G, Yang GM, Yoon S. Longitudinal patterns and predictors of healthcare utilization among cancer patients on home-based palliative care in Singapore: a group-based multi-trajectory analysis. BMC Med 2022; 20:313. [PMID: 36131339 PMCID: PMC9494890 DOI: 10.1186/s12916-022-02513-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Home-based palliative care (HPC) is considered to moderate the problem of rising healthcare utilization of cancer patients at end-of-life. Reports however suggest a proportion of HPC patients continue to experience high care intensity. Little is known about differential trajectories of healthcare utilization in patients on HPC. Thus, we aimed to uncover the heterogeneity of healthcare utilization trajectories in HPC patients and identify predictors of each utilization pattern. METHODS This is a cohort study of adult cancer patients referred by Singapore Health Services to HCA Hospice Service who died between 1st January 2018 and 31st March 2020. We used patient-level data to capture predisposing, enabling, and need factors for healthcare utilization. Group-based multi-trajectory modelling was applied to identify trajectories for healthcare utilization based on the composite outcome of emergency department (ED) visits, hospitalization, and outpatient visits. RESULTS A total of 1572 cancer patients received HPC (median age, 71 years; interquartile range, 62-80 years; 51.1% female). We found three distinct trajectory groups: group 1 (31.9% of cohort) with persistently low frequencies of healthcare utilization, group 2 (44.1%) with persistently high frequencies, and group 3 (24.0%) that begin with moderate frequencies, which dropped over the next 9 months before increasing in the last 3 months. Predisposing (age, advance care plan completion, and care preferences), enabling (no medical subsidy, primary decision maker), and need factors (cancer type, comorbidity burden and performance status) were significantly associated with group membership. High symptom needs increased ED visits and hospitalizations in all three groups (ED visits, group 1-3: incidence rate ratio [IRR] 1.74-6.85; hospitalizations, group 1-3: IRR 1.69-6.60). High home visit intensity reduced outpatient visits in all three groups (group 1-3 IRR 0.54-0.84), while it contributed to reduction of ED visits (IRR 0.40; 95% CI 0.25-0.62) and hospitalizations (IRR 0.37; 95% CI 0.24-0.58) in group 2. CONCLUSIONS This study on HPC patients highlights three healthcare utilization trajectories with implications for targeted interventions. Future efforts could include improving advance care plan completion, supporting care preferences in the community, proactive interventions among symptomatic high-risk patients, and stratification of home visit intensity.
Collapse
Affiliation(s)
- Qingyuan Zhuang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.
| | | | - Whee Sze Ong
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Cherylyn Qun Zhen Foo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Su Yan Yap
- Palliative Care Services, Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Guozhang Lee
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Grace Meijuan Yang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.,Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Centre for Population Health Research and Implementation, Singapore Regional Health System, Singapore, Singapore
| |
Collapse
|
4
|
Prater LC, O'Rourke B, Schnell P, Xu W, Li Y, Gustin J, Lockwood B, Lustberg M, White S, Happ MB, Retchin SM, Wickizer TM, Bose-Brill S. Examining the Association of Billed Advance Care Planning With End-of-Life Hospital Admissions Among Advanced Cancer Patients in Hospice. Am J Hosp Palliat Care 2021; 39:504-510. [PMID: 34427154 DOI: 10.1177/10499091211039449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Laura C Prater
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.,Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Brian O'Rourke
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Patrick Schnell
- Division of Biostatistics, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Wendy Xu
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Yiting Li
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Jillian Gustin
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Bethany Lockwood
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Maryam Lustberg
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus OH, USA.,James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Susan White
- James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mary Beth Happ
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Sheldon M Retchin
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Thomas M Wickizer
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
5
|
|
6
|
Taylor R, Ellis J, Gao W, Searle L, Heaps K, Davies R, Hawksworth C, Garcia-Perez A, Colclough G, Walker S, Wee B. A scoping review of initiatives to reduce inappropriate or non-beneficial hospital admissions and bed days in people nearing the end of their life: much innovation, but limited supporting evidence. BMC Palliat Care 2020; 19:24. [PMID: 32103745 PMCID: PMC7045380 DOI: 10.1186/s12904-020-0526-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background Hospitalisation during the last weeks of life when there is no medical need or desire to be there is distressing and expensive. This study sought palliative care initiatives which may avoid or shorten hospital stay at the end of life and analysed their success in terms reducing bed days. Methods Part 1 included a search of literature in PubMed and Google Scholar between 2013 and 2018, an examination of governmental and organisational publications plus discussions with external and co-author experts regarding other sources. This initial sweep sought to identify and categorise relevant palliative care initiatives. In Part 2, we looked for publications providing data on hospital admissions and bed days for each category. Results A total of 1252 abstracts were reviewed, resulting in ten broad classes being identified. Further screening revealed 50 relevant publications describing a range of multi-component initiatives. Studies were generally small and retrospective. Most researchers claim their service delivered benefits. In descending frequency, benefits identified were support in the community, integrated care, out-of-hours telephone advice, care home education and telemedicine. Nurses and hospices were central to many initiatives. Barriers and factors underpinning success were rarely addressed. Conclusions A wide range of initiatives have been introduced to improve end-of-life experiences. Formal evidence supporting their effectiveness in reducing inappropriate/non-beneficial hospital bed days was generally limited or absent. Trial registration N/A
Collapse
Affiliation(s)
| | | | - Wei Gao
- Cicely Saunders Institute, London, UK
| | | | | | - Robert Davies
- Stgilesmedical Ltd, The Vestry House, St Giles High Street, London, WC2H 8LG, UK.,Stgilesmedical GmbH, Berlin, Germany
| | - Claire Hawksworth
- Stgilesmedical Ltd, The Vestry House, St Giles High Street, London, WC2H 8LG, UK
| | - Angela Garcia-Perez
- Stgilesmedical Ltd, The Vestry House, St Giles High Street, London, WC2H 8LG, UK
| | | | - Steven Walker
- Stgilesmedical Ltd, The Vestry House, St Giles High Street, London, WC2H 8LG, UK. .,Stgilesmedical GmbH, Berlin, Germany.
| | - Bee Wee
- Harris Manchester College, University of Oxford, Oxford, UK.,Sir Michael Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
7
|
Cao T, Johnson A, Coogle J, Zuzelski A, Fitzgerald S, Kapadia V, Stoltzfus K. Incidence and Characteristics Associated with Hospital Readmission after Discharge to Home Hospice. J Palliat Med 2019; 23:233-239. [PMID: 31513454 DOI: 10.1089/jpm.2019.0246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Home hospice is designed to provide comfort to patients at the end of their life and hospital readmission is incongruent with this goal. Objective: The purpose of this study was to investigate the incidence of and characteristics associated with hospital readmissions from home hospice over a two-year period. Design/Subjects: This was a retrospective cohort study of 705 inpatients discharged from a quaternary academic medical center to home hospice from January 1, 2016 to December 31, 2017. Measures: The primary outcome was incidence of hospital readmission after discharge to home hospice. Multivariate regression with stepwise forward selection was used to identify characteristics associated with readmission. Results: The incidence of readmission was found to be 10.50% (n = 74), and the median days from discharge to readmission were 32.50 days (interquartile range = 14.00, 75.00). Reasons for readmission were: unanticipated new medical issue (n = 33, 44.59%), uncontrolled symptoms (n = 25, 33.78%), misunderstanding of hospice status (n = 12, 16.22%), and caregiver distress (n = 4, 5.41%). The following characteristics were associated with readmission: female versus male (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 1.16-3.32), non-white versus white (OR = 2.40; 95% CI: 1.36-4.24), and hospice diagnosis of cardiac disease versus all other diagnoses (OR = 4.40; 95% CI: 2.06-9.37). Conclusions: Compared with prior studies, our findings showed a lower incidence of readmission, 10.50%, from home hospice. In addition, those who are female, non-white, or have a hospice diagnosis of cardiac disease are more likely to be readmitted.
Collapse
Affiliation(s)
- Thuy Cao
- University of Kansas Medical Center School of Medicine, Kansas City, Kansas
| | - Amy Johnson
- University of Kansas Medical Center School of Medicine, Kansas City, Kansas
| | - Justin Coogle
- University of Kansas Medical Center School of Medicine, Kansas City, Kansas
| | - Adam Zuzelski
- University of Kansas Medical Center School of Medicine, Kansas City, Kansas
| | - Sharon Fitzgerald
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas
| | - Vishal Kapadia
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Ky Stoltzfus
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| |
Collapse
|
8
|
Prater LC, Wickizer T, Bower JK, Bose-Brill S. The Impact of Advance Care Planning on End-of-Life Care: Do the Type and Timing Make a Difference for Patients With Advanced Cancer Referred to Hospice? Am J Hosp Palliat Care 2019; 36:1089-1095. [DOI: 10.1177/1049909119848987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: This study aimed to determine the impact of advanced care planning (ACP) on potentially avoidable hospital admissions at the end of life (EOL) among a sample of hospice-referred patients with cancer, in order to present actionable considerations for the practicing clinician. Methods: This study was designed as a retrospective cohort using electronic health record data that assessed likelihood of hospital admissions in the last 30 days of life for 1185 patients with a primary diagnosis of cancer, referred to hospice between January 1, 2014, and December 31, 2015, at a large academic medical center. Inverse probability treatment weighting based on calculated propensity scores balanced measured covariates between those with and without ACP at baseline. Odds ratios (ORs) were calculated from estimated potential outcome means for the impact of ACP on admissions in the last 30 days of life. Results: A verified do-not-resuscitate (DNR) order prior to the last 30 days of life was associated with reduced odds of admission compared to those without a DNR (OR = 0.30; P < .001). An ACP note in the problem list prior to the last 30 days of life was associated with reduced odds of admission compared to those without an ACP note (OR = 0.71, P = .042), and further reduced odds if done 6 months prior to death (OR = 0.35, P < .001). Conclusions: This study shows that dedicated ACP documentation is associated with fewer admissions in the last 30 days of life for patients with advanced cancer referred to hospice. Improving ACP processes prior to hospice referral holds promise for reducing EOL admissions.
Collapse
Affiliation(s)
- Laura C. Prater
- Department of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thomas Wickizer
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Julie K. Bower
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Seuli Bose-Brill
- Department of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
9
|
Manthri S, Simmons C, Cepeda OA. Outcomes of Palliative Care Consults With Hospitalized Veterans. Fed Pract 2018; 35:44-47. [PMID: 30766386 PMCID: PMC6366796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Families and patients receive emotional support and better care planning after palliative care consultations.
Collapse
Affiliation(s)
- Sukesh Manthri
- and are Fellows at St. Louis University in Missouri. is a Palliative Care Physician at the John Cochran Division of the VA St. Louis Health Care System. Dr. Cepeda also is Director of the Hospice and Palliative Medicine Fellowship Program and Assistant Professor of Medicine at Saint Louis University School of Medicine
| | - Cameron Simmons
- and are Fellows at St. Louis University in Missouri. is a Palliative Care Physician at the John Cochran Division of the VA St. Louis Health Care System. Dr. Cepeda also is Director of the Hospice and Palliative Medicine Fellowship Program and Assistant Professor of Medicine at Saint Louis University School of Medicine
| | - Oscar A Cepeda
- and are Fellows at St. Louis University in Missouri. is a Palliative Care Physician at the John Cochran Division of the VA St. Louis Health Care System. Dr. Cepeda also is Director of the Hospice and Palliative Medicine Fellowship Program and Assistant Professor of Medicine at Saint Louis University School of Medicine
| |
Collapse
|
10
|
Treece J, Ghouse M, Rashid S, Arikapudi S, Sankhyan P, Kohli V, O’Neill L, Addo-Yobo E, Bhattad V, Baumrucker SJ. The Effect of Hospice on Hospital Admission and Readmission Rates: A Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2018. [DOI: 10.1177/1084822318761105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Symptom control may become challenging for terminally ill patients as they near the end of life. Patients often seek hospital admission to address symptoms, such as pain, nausea, vomiting, and restlessness. Alternatively, palliative medicine focuses on the control and mitigation of symptoms, while allowing patients to maintain their quality of life, whether in an outpatient or inpatient setting. Hospice care provides, in addition to inpatient care at a hospice facility or in a hospital, the option for patients to receive symptom management at home. This option for symptom control in the outpatient setting is essential to preventing repeated and expensive hospital readmissions. This article discusses the impact of hospice care on hospital readmission rates.
Collapse
Affiliation(s)
| | | | - Saima Rashid
- East Tennessee State University, Johnson City, TN, USA
| | | | | | - Varun Kohli
- East Tennessee State University, Johnson City, TN, USA
| | - Luke O’Neill
- East Tennessee State University, Johnson City, TN, USA
| | | | | | | |
Collapse
|
11
|
Joseph R, Brown-Manhertz D, Ikwuazom S, Singleton JK. The effectiveness of structured interdisciplinary collaboration for adult home hospice patients on patient satisfaction and hospital admissions and re-admissions: a systematic review. ACTA ACUST UNITED AC 2018; 14:108-39. [PMID: 26878925 DOI: 10.11124/jbisrir-2016-2254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Patient satisfaction and hospital re-admission rates are the two major outcomes for measuring quality of healthcare delivery. Interdisciplinary collaboration, a concept that describes coordination of care between multiple healthcare professionals and patients and families to deliver the highest quality of care across settings, is fundamental to improving patient outcomes. Home hospice care is palliative in nature and is a critical segment of patient care. To date, no systematic review has been undertaken to determine the effectiveness of structured interdisciplinary collaboration in the home hospice setting in relation to patient satisfaction and hospital readmission. OBJECTIVE The aim of the review was to synthesize the best available evidence on the effectiveness of structured interdisciplinary collaboration on patient satisfaction and hospital admission and re-admission rates for adults receiving home hospice services. INCLUSION CRITERIA Adults, male and female (18 years old or older), receiving home hospice services or transitioning from hospital to home hospice servicesThe studies that evaluate interdisciplinary collaboration among the hospice team providing home hospice services in the home care settingsIn this review, randomized controlled trials and quasi-experimental studies were considered for inclusion.Patient satisfaction and all cause hospital admissions and re-admission rates. SEARCH STRATEGY Published and unpublished literature in the English language was sought from the inception of the databases through August 15, 2014. The databases searched included: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Nursing & Allied Health Source, Health Source: Nursing/Academic Edition and ProQuest Health Management. A search of grey literature and any relevant homecare/hospice websites was also performed. RESULTS There were no studies located that met the inclusion requirements of this review. There were no text or opinion pieces that were specific to structured interdisciplinary collaboration among the hospice team in home care settings on patient satisfaction and hospital readmission. CONCLUSION There is currently no evidence available to determine the effectiveness of structured interdisciplinary collaboration among hospice teams in home care settings in regard to patient satisfaction and hospital readmission. IMPLICATIONS FOR PRACTICE No conclusive recommendations can be made regarding the effectiveness of structured interdisciplinary collaboration among home hospice teams in home care settings in regard to patient satisfaction and hospital readmission. IMPLICATIONS FOR RESEARCH Quantitative and qualitative research studies are urgently required to determine the effectiveness of structured interdisciplinary collaboration among home hospice teams in home care settings in regard to patient satisfaction and hospital readmission.
Collapse
Affiliation(s)
- Rincy Joseph
- 1. College of Health Professions, Pace University, New York, NY, USA2. The Northeast Institute for Evidence Synthesis and Translation (NEST): a Collaborating Center of the Joanna Briggs Institute
| | | | | | | |
Collapse
|
12
|
Wilson A, Martins-Welch D, Williams M, Tortez L, Kozikowski A, Earle B, Attivissimo L, Rosen L, Pekmezaris R. Risk Factor Assessment of Hospice Patients Readmitted within 7 Days of Acute Care Hospital Discharge. Geriatrics (Basel) 2018; 3:geriatrics3010004. [PMID: 31011052 PMCID: PMC6371090 DOI: 10.3390/geriatrics3010004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 11/16/2022] Open
Abstract
Factors surrounding readmission rates for hospice patients within seven days are still relatively unknown. The present study specifically investigates the seven-day readmission rate of patients newly discharged to hospice, and the predictive factors associated with readmission for this population. In a retrospective case-control study, we seek to identify potential predictors by comparing the characteristics of patients discharged to hospice and readmitted within one week to patients who were not readmitted. Cases (n = 46) were patients discharged to home hospice and readmitted to the hospital within seven days. Controls (n = 117) were patients discharged to home hospice and not readmitted to the hospital within seven days. Significant risk factors for readmission within seven days were found to be: age (p < 0.01), race (p < 0.001), language (p < 0.001), and insurance (p < 0.001). Further study of these predictors may identify opportunities for interventions that address patient and family concerns that may lead to readmission.
Collapse
Affiliation(s)
- Anthony Wilson
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
| | - Diana Martins-Welch
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
| | - Myia Williams
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
- Correspondence: ; Tel.: +1-516-600-1479
| | - Leanne Tortez
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
| | - Andrzej Kozikowski
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
| | - Bridget Earle
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
| | | | - Lisa Rosen
- Feinstein Institute for Medical Research, Manhasset, NY 11030, USA;
| | - Renee Pekmezaris
- Northwell Health, Manhasset, NY 11030, USA; (A.W.); (D.M.-W.); (L.T.); (A.K.); (B.E.); (R.P.)
| |
Collapse
|
13
|
Whitney RL, Bell JF, Tancredi DJ, Romano PS, Bold RJ, Joseph JG. Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis. J Clin Oncol 2017; 35:3610-3617. [PMID: 28850290 PMCID: PMC5946701 DOI: 10.1200/jco.2017.72.4963] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose Among individuals with advanced cancer, frequent hospitalization increasingly is viewed as a hallmark of poor-quality care. We examined hospitalization rates and individual- and hospital-level predictors of rehospitalization among individuals with advanced cancer in the year after diagnosis. Methods Individuals diagnosed with advanced breast, colorectal, non-small-cell lung, or pancreatic cancer from 2009 to 2012 (N = 25,032) were identified with data from the California Cancer Registry (CCR). After linkage with inpatient discharge data, multistate and log-linear Poisson regression models were used to calculate hospitalization rates and to model rehospitalization in the year after diagnosis, accounting for survival. Results In the year after diagnosis, 71% of individuals with advanced cancer were hospitalized, 16% had three or more hospitalizations, and 64% of hospitalizations originated in the emergency department. Rehospitalization rates were significantly associated with black non-Hispanic (incidence rate ratio [IRR], 1.29; 95% CI, 1.17 to 1.42) and Hispanic (IRR, 1.11; 95% CI, 1.03 to 1.20) race/ethnicity; public insurance (IRR, 1.37; 95% CI, 1.23 to 1.47) and no insurance (IRR, 1.17; 95% CI, 1.02 to 1.35); lower socioeconomic status quintiles (IRRs, 1.09 to 1.29); comorbidities (IRRs, 1.13 to 1.59); and pancreatic (IRR, 2.07; 95% CI, 1.95 to 2.20) and non-small-cell lung (IRR, 1.69; 95% CI, 1.54 to 1.86) cancers versus colorectal cancer. Rehospitalization rates were significantly lower after discharge from a hospital that had an outpatient palliative care program (IRR, 0.90; 95% CI, 0.83 to 0.97) and were higher after discharge from a for-profit hospital (IRR, 1.33; 95% CI, 1.14 to 1.56). Conclusion Individuals with advanced cancer experience a heavy burden of hospitalization in the year after diagnosis. Efforts to reduce hospitalization and provide care congruent with patient preferences might target individuals at higher risk. Future work might explore access to palliative care in the community and related health care use among individuals with advanced cancer.
Collapse
Affiliation(s)
- Robin L. Whitney
- Robin L. Whitney, University of California, San Francisco, Fresno; and Robin L. Whitney, Janice F. Bell, Daniel J. Tancredi, Patrick S. Romano, Richard J. Bold, and Jill G. Joseph, University of California, Davis, Sacramento, CA
| | - Janice F. Bell
- Robin L. Whitney, University of California, San Francisco, Fresno; and Robin L. Whitney, Janice F. Bell, Daniel J. Tancredi, Patrick S. Romano, Richard J. Bold, and Jill G. Joseph, University of California, Davis, Sacramento, CA
| | - Daniel J. Tancredi
- Robin L. Whitney, University of California, San Francisco, Fresno; and Robin L. Whitney, Janice F. Bell, Daniel J. Tancredi, Patrick S. Romano, Richard J. Bold, and Jill G. Joseph, University of California, Davis, Sacramento, CA
| | - Patrick S. Romano
- Robin L. Whitney, University of California, San Francisco, Fresno; and Robin L. Whitney, Janice F. Bell, Daniel J. Tancredi, Patrick S. Romano, Richard J. Bold, and Jill G. Joseph, University of California, Davis, Sacramento, CA
| | - Richard J. Bold
- Robin L. Whitney, University of California, San Francisco, Fresno; and Robin L. Whitney, Janice F. Bell, Daniel J. Tancredi, Patrick S. Romano, Richard J. Bold, and Jill G. Joseph, University of California, Davis, Sacramento, CA
| | - Jill G. Joseph
- Robin L. Whitney, University of California, San Francisco, Fresno; and Robin L. Whitney, Janice F. Bell, Daniel J. Tancredi, Patrick S. Romano, Richard J. Bold, and Jill G. Joseph, University of California, Davis, Sacramento, CA
| |
Collapse
|
14
|
Phongtankuel V, Johnson P, Reid MC, Adelman RD, Grinspan Z, Unruh MA, Abramson E. Risk Factors for Hospitalization of Home Hospice Enrollees Development and Validation of a Predictive Tool. Am J Hosp Palliat Care 2017; 34:806-813. [PMID: 27448668 PMCID: PMC5684698 DOI: 10.1177/1049909116659439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Over 10% of hospice patients experience at least 1 care transition 6 months prior to death. Transitions at the end of life, particularly from hospice to hospital, result in burdensome and fragmented care for patients and families. Little is known about factors that predict hospitalization in this population. OBJECTIVES To develop and validate a model predictive of hospitalization after enrollment into home hospice using prehospice admission risk factors. DESIGN Retrospective cohort study using Medicare fee-for-service claims. PARTICIPANTS Patients enrolled into the Medicare hospice benefit were ≥18 years old in 2012. OUTCOME MEASURED Hospitalization within 2 days from a hospice discharge. RESULTS We developed a predictive model using 61 947 hospice enrollments, of which 3347 (5.4%) underwent a hospitalization. Seven variables were associated with hospitalization: age 18 to 55 years old (adjusted odds ratio [95% confidence interval]: 2.94 [2.41-3.59]), black race (2.13 [1.93-2.34]), east region (1.97 [1.73-2.24]), a noncancer diagnosis (1.32 [1.21-1.45]), 4 or more chronic conditions (8.11 [7.19-9.14]), 2 or more prior hospice enrollments (1.75 [1.35-2.26]), and enrollment in a not-for-profit hospice (2.01 [1.86-2.18]). A risk scoring tool ranging from 0 to 29 was developed, and a cutoff score of 18 identified hospitalized patients with a positive predictive value of 22%. CONCLUSIONS Reasons for hospitalization among home hospice patients are complex. Patients who are younger, belong to a minority group, and have a greater number of chronic conditions are at increased odds of hospitalization. Our newly developed predictive tool identifies patients at risk for hospitalization and can serve as a benchmark for future model development.
Collapse
Affiliation(s)
- Veerawat Phongtankuel
- 1 Department of Medicine, Division of Geriatrics and Palliative Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - P Johnson
- 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - M C Reid
- 1 Department of Medicine, Division of Geriatrics and Palliative Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - R D Adelman
- 1 Department of Medicine, Division of Geriatrics and Palliative Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - Z Grinspan
- 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
- 3 Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - M A Unruh
- 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - E Abramson
- 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
- 3 Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
15
|
Characteristics of advanced cancer patients who were readmitted to an acute palliative/supportive care unit. Support Care Cancer 2017; 25:1947-1952. [PMID: 28161787 DOI: 10.1007/s00520-017-3604-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to assess the characteristics of patients readmitted to an acute supportive/palliative care unit (ASPCU), the reasons for readmission, and the outcome after receiving specialistic assessment and treatment. METHODS A consecutive sample of patients was assessed for a period of 10 months. Epidemiological characteristics, including age, gender, Karnofsky level, diagnosis, caregivers, education, disease awareness, kind of admission, and anticancer treatment in the previous 30 days, were recorded, as well as hospital stay, death, and discharge at home. The principal reasons for admission were recorded. Symptom intensity and opioid doses, expressed as oral morphine equivalents, were also measured. RESULTS In the study period, 79 (25.2%) readmissions were recorded. Thirty-seven (46.8%) readmissions occurred within 30 days after discharge. Pain was more frequently reported as indication for admission at the first and the second readmission in comparison with the first admission. The burden of symptoms was significantly higher in patients with a readmission in comparison with patients at the first admission. Opioid doses, expressed as oral morphine equivalents, were significantly different between the first admission and readmissions. In both patients at the first admission or readmission, a significant decrease in symptom intensity has been reported at discharge. CONCLUSION About 25% of patients discharged from an ASCPU are expected to be readmitted for reemerging of clinical problems. Re-exacerbation of pain seems to be the most frequent reason. A further clinical reassessment and treatment were equally effective in controlling the symptom burden of these patients at any readmission.
Collapse
|
16
|
Whitney P, Chuang EJ. Relationship between insurance and 30-day readmission rates in patients 65 years and older discharged from an acute care hospital with hospice services. J Hosp Med 2016; 11:688-693. [PMID: 27222206 DOI: 10.1002/jhm.2613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/08/2016] [Accepted: 04/28/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients who are dual eligible for both Medicare and Medicaid have previously been shown to have increased healthcare utilization and cost. However, this relationship has not been examined for patients at the end of life. Dual eligible patients enrolled in hospice may receive more comprehensive care in the community, reducing readmissions in the final weeks or months of life. OBJECTIVE Determine whether patients who have dual coverage with Medicare and Medicaid and are discharged with referral to hospice services after palliative care consult during their hospitalization differ in their 30-day readmission rate compared with similar patients with other types of insurance. DESIGN Retrospective cohort study. SETTING Three acute care hospitals affiliated with Montefiore Medical Center in the Bronx, New York. PATIENTS In total, 2755 inpatients who received palliative care consultation and were discharged with hospice services. PREDICTOR Dual eligible for Medicare and Medicaid compared with other insurance status. MEASUREMENTS Readmission to Montefiore Medical Center for any reason within 30 days of the index admission. RESULTS Overall, 9.24% of patients with dual Medicare and Medicaid coverage were readmitted within 30 days compared with 13.12% of others (adjusted odds ratio: 0.77; 95% confidence interval: 0.59-0.98; P = 0.041). CONCLUSIONS Dual eligibility for Medicare and Medicaid is associated with lower 30-day readmission rates in patients enrolled in a hospice program. Insurance coverage that increases access to custodial care (home attendant hours and residential care) may help decrease burdensome hospital readmissions near the end of life. Journal of Hospital Medicine 2016;11:688-693. © 2016 Society of Hospital Medicine.
Collapse
Affiliation(s)
- Patricia Whitney
- Department of Family Medicine, Palliative Care Service, University of Vermont Medical Center, Burlington, Vermont
| | - Elizabeth J Chuang
- Department of Family and Social Medicine, Palliative Care Service, Montefiore Medical Center, Bronx, New York.
| |
Collapse
|
17
|
Kim SL, Tarn DM. Effect of Primary Care Involvement on End-of-Life Care Outcomes: A Systematic Review. J Am Geriatr Soc 2016; 64:1968-1974. [PMID: 27550751 DOI: 10.1111/jgs.14315] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the relationship between primary care involvement in end-of-life (EOL) care and health and utilization outcomes. DESIGN Systematic review using MEDLINE and Web of Science. SETTING All English literature published between 1994 and August 31, 2014, that included terms related to primary care providers (PCPs), continuity of care, EOL care, and palliative care. PARTICIPANTS Individuals receiving care from a PCP at the end of life. MEASUREMENTS Study design, subject characteristics, study outcomes and results. RESULTS Of 2,812 studies screened, 13 were included in this study. The studies were mostly conducted in the United States (n = 5) and Canada (n = 4) and analyzed data collected from 1989 to 2010. Almost all studies used different definitions of PCP involvement in care, but in general, individuals who received more care from PCPs were more likely to be discharged or die with supportive care (home or hospice) than those receiving less PCP care. A few studies indicated that individuals seeing a PCP were less likely to have hospital or emergency department admissions, although the evidence for this was mixed. Studies linking PCP involvement to resource use, symptom management, and survival had mixed results or showed no association. CONCLUSION When PCPs are involved in EOL care, people are more likely to die out of the hospital. Thus, the relationship with the PCP may be particularly important in EOL care, because PCPs may help individual establish goals of care and determine treatment preferences.
Collapse
Affiliation(s)
- Sion L Kim
- University of Texas Medical School at Houston, Houston, Texas.
| | - Derjung M Tarn
- Department of Family Medicine, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California
| |
Collapse
|
18
|
Liu OY, Malmstrom T, Burhanna P, Rodin MB. The Evolution of an Inpatient Palliative Care Consultation Service in an Urban Teaching Hospital. Am J Hosp Palliat Care 2016; 34:47-52. [DOI: 10.1177/1049909115610077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Research on inpatient palliative medicine reports quality-of-life outcomes and selected “hard” outcomes including pain scores, survival, and readmissions. Objective: This case study reports the evolution of an inpatient palliative consultation (IPC) team to show how IPC induces culture change in a hospital that previously had no palliative care. Design: Retrospective chart review. Setting: A Catholic university-affiliated, inner-city hospital. Population: A total of 1700 consecutive adult inpatients from May 2009 to October 2013. Measures: Consultation records enumerated demographics, code status, powers of attorney, referring physician, reason for consultation, and discharge destination. Deidentified data were uploaded to a spreadsheet. Simple descriptive statistics were calculated. Results: Requests originated from internal medicine (24%), geriatrics (21%), neurology (including stroke and neurosurgery, 14.3%), medical intensive care unit (MICU, 12.2%), and hematology–oncology (10.3%). The MICU consults increased 17.6% over time. The numbers of consults nearly doubled after trainees began rounding with the service. Hospice discharges increased by 9.2%. Palliative management of in-hospital expirations increased 2- to 3-fold. The most common consultation requests were for pain and nonpain symptoms, establishing goals of care for patients experiencing clinical decline and convening family meetings in cases of divided judgment. Conclusion: We describe the evolution of palliative care in a safety-net hospital. Medicine services which are largely resident run adopted early. Specialty services that are attending driven adopted later. We believe house staff and nurses were the initial change agents. The number of consultations increased when house staff and students began rotating on the service suggesting unmet demand due to the limited supply of providers.
Collapse
Affiliation(s)
- On Ying Liu
- St Louis University Medical School, St Louis, MO, USA
| | - Theodore Malmstrom
- Department of Neurology and Psychiatry, St Louis University Medical School, St Louis, MO, USA
- Division of Geriatrics, Department of Internal Medicine, St Louis University Medical School, St Louis, MO, USA
| | - Patricia Burhanna
- Palliative nurse practitioner, St. Louis University Hospital, St Louis, MO, USA
| | - Miriam B. Rodin
- Division of Geriatrics, Department of Internal Medicine, St Louis University Medical School, St Louis, MO, USA
| |
Collapse
|
19
|
Tan WS, Lee A, Yang SY, Chan S, Wu HY, Ng CWL, Heng BH. Integrating palliative care across settings: A retrospective cohort study of a hospice home care programme for cancer patients. Palliat Med 2016; 30:634-41. [PMID: 26867937 DOI: 10.1177/0269216315622126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Terminally ill patients at the end-of-life do transit between care settings due to their complex care needs. Problems of care fragmentation could result in poor quality of care. AIM We aimed to evaluate the impact of an integrated hospice home care programme on acute care service usage and on the share of home deaths. SETTINGS/PARTICIPANTS The retrospective study cohort comprised patients who were diagnosed with cancer, had an expected prognosis of 1 year or less, and were referred to a home hospice. The intervention group comprised deceased patients enrolled in the integrated hospice home care programme between September 2012 and June 2014. The historical comparison group comprised deceased patients who were referred to other home hospices between January 2007 and January 2011. RESULTS There were 321 cases and 593 comparator subjects. Relative to the comparator group, the share of hospital deaths was significantly lower for programme participants (12.1% versus 42.7%). After adjusting for differences at baseline, the intervention group had statistically significantly lower emergency department visits at 30 days (incidence rate ratio: 0.38; 95% confidence interval: 0.31-0.47), 60 days (incidence rate ratio: 0.61; 95% confidence interval: 0.54-0.69) and 90 days (incidence rate ratio: 0.69; 95% confidence interval: 0.62-0.77) prior to death. Similar results held for the number of hospitalisations at 30 days (incidence rate ratio: 0.48; 95% confidence interval: 0.40-0.58), 60 days (incidence rate ratio: 0.71; 95% confidence interval: 0.62-0.82) and 90 days (incidence rate ratio: 0.77; 95% confidence interval: 0.68-0.88) prior to death. CONCLUSION Our results demonstrated that by integrating services between acute care and home hospice care, a reduction in acute care service usage could occur.
Collapse
Affiliation(s)
- Woan Shin Tan
- Health Services & Outcomes Research Department, National Healthcare Group, Singapore
| | - Angel Lee
- Palliative Medicine Department, Tan Tock Seng Hospital, Singapore Dover Park Hospice, Singapore
| | - Sze Yee Yang
- Palliative Medicine Department, Tan Tock Seng Hospital, Singapore Dover Park Hospice, Singapore
| | | | - Huei Yaw Wu
- Palliative Medicine Department, Tan Tock Seng Hospital, Singapore Dover Park Hospice, Singapore
| | - Charis Wei Ling Ng
- Health Services & Outcomes Research Department, National Healthcare Group, Singapore
| | - Bee Hoon Heng
- Health Services & Outcomes Research Department, National Healthcare Group, Singapore
| |
Collapse
|
20
|
Arias Rojas M, García-Vivar C. The transition of palliative care from the hospital to the home: a narrative review of experiences of patients and family caretakers. INVESTIGACION Y EDUCACION EN ENFERMERIA 2015; 33:482-491. [PMID: 28569956 DOI: 10.17533/udea.iee.v33n3a12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/15/2015] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This work sought to identify, analyze, and synthesize the qualitative studies published on the experiences of patients and family caretakers during the transition of palliative care from the hospital to the home. METHODOLOGY A narrative review was conducted on the PubMed, Cochrane Central, ScienceDirect, Ovid Nursing, CINALH, Scielo, and Bireme databases, from 2000 to 2014. RESULTS After the analysis and comparison of the data, the results were grouped into six themes: (1) the dyad and its knowledge regarding the diagnosis and prognosis; (2) emotions experienced by the family caretaker and the patient during discharge; (3) effective communication among those involved with the care; (4) education for the care of the person at home; (5) continuous support to the dyad at home, and (6) care overload: social support for the family caretaker. CONCLUSION Patients and relatives in palliative care experience a broad range of needs during the transition process from the hospital to the home, which are often not covered by healthcare professionals. This review evidences the need to research further on the experiences of these families, especially during the stage prior to the transfer to the domicile.
Collapse
|
21
|
Galen BT. Inpatient end-of-life decisions informed by definitive diagnosis. J Palliat Med 2014; 17:1295. [PMID: 25401404 DOI: 10.1089/jpm.2014.0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Benjamin T Galen
- Department of Medicine, Division of Hospital Medicine, Montefiore Medical Center/Albert Einstein College of Medicine , Bronx, New York
| |
Collapse
|