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Shah K, Janssen A, Donnelly C, Shaw T. Digital Educational Interventions for the Development of Advanced Care Planning Skills for Medical Practitioners: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 43:181-187. [PMID: 36215159 DOI: 10.1097/ceh.0000000000000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Medical practitioners are important facilitators of advanced care planning but are often reluctant to engage in these conversations with patients and their families. Barriers to participation can be addressed through medical education for medical practitioners. INTRODUCTION The primary objective was to examine the extent to which digital educational interventions are used to foster advanced care planning skills. Secondary objectives include understanding the acceptability of these interventions and whether electronic health records can be used to personalize learning. METHODS Online databases were used to identify relevant articles published from 2008 to 2021. Nine articles which evaluated the impact of digital learning for medical practitioners were selected. Studies eligible for inclusion in the review assessed changes in knowledge, attitudes, and practice regarding skills used in advanced care planning. RESULTS All publications used a pre-post study design with education delivered solely online. Only three studies focused on completing advance care plans or directives (33%). All but two studies recorded improvements in knowledge and/or attitudes toward planning (78%) while three studies recorded improvements in clinical practice (33%). The review suggests prior clinical or personal experiences could be used to personalize education. DISCUSSION The literature revealed that using digital education to develop advanced care planning skills is relatively unexplored despite the ability of this type of learning to improve professional knowledge and confidence. Digital devices can also improve access to relevant information at the point-of-care. Personalized interventions that incorporate prior clinical experiences, potentially extracted from health records, could be used to optimize outcomes.
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Affiliation(s)
- Kavisha Shah
- Ms. Shah: Research Assistant, The University of Sydney, Faculty of Medicine and Health, Sydney, Australia, and Sydney West Translational Cancer Research Centre, Sydney, Australia. Dr. Janssen: Senior Research Fellow, the University of Sydney, Faculty of Medicine and Health, Sydney, Australia. Mrs Donnelly: Senior Research Officer, PhD Candidate, The University of Sydney, Faculty of Medicine and Health, Sydney, Australia, and Sydney West Translational Cancer Research Centre, Sydney, Australia. Prof. Shaw: Director of Research in Implementation Science and Health (PhD, BSc), the University of Sydney, Faculty of Medicine and Health, Sydney, Australia
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Shu Z, Wang Y, Li T, Jing L, Sun X. Instrument development of health providers' Knowledge, Attitude and Practice of Hospice Care Scale in China. Int J Health Plann Manage 2020; 36:364-380. [PMID: 33063349 DOI: 10.1002/hpm.3074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/25/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To match the reform of hospice development in China, this study aimed to construct an indigenized health providers' Knowledge, Attitude and Practice of Hospice Care (KAPHC) Scale in China with good validity and reliability. METHODS We used three steps to develop the scale, establishing items-pool firstly based on literature review and expert consultation, followed by forming a draft-scale design through synthetically consideration, and finally modifying the draft by conducting a self-administrative survey in sampled institution and testing the reliability and validity by statistical analysis. RESULTS The KAPHC Scale was comprised of 15 knowledge items, 24 attitude items and 22 practice items. In the part of knowledge, the Cronbach's α coefficient was 0.686, the average difficulty was 0.62 and average discrimination was 0.46. The attitude items were divided into four domains (KMO = 0.770), with Cronbach's α coefficient of 0.868. The practice items included confidence of practices and self-reported behaviors (KMO = 0.732), with Cronbach's α coefficient of 0.958. CONCLUSION The KAPHC Scale demonstrated good validity and reliability. As an effective tool, the scale may contribute to assessing health providers' KAP status of hospice care and exploring their future education needs in mainland China.
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Affiliation(s)
- Zhiqun Shu
- Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Jiaotong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Yiting Wang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tiantian Li
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Clinic Medical College, Anhui Medical University, Anhui, China
| | - Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoming Sun
- Zhongshan Hospital, Fudan University, Shanghai, China.,School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Pudong Institution for Health Development, Shanghai, China
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Suwanabol PA, Vitous CA, Perumalswami CR, Li SH, Raja N, Dillon BR, Lee CW, Forman J, Silveira MJ. Surgery Residents' Experiences With Seriously-Ill and Dying Patients: An Opportunity to Improve Palliative and End-of-Life Care. JOURNAL OF SURGICAL EDUCATION 2020; 77:582-597. [PMID: 32063510 DOI: 10.1016/j.jsurg.2019.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/25/2019] [Accepted: 12/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe how and when surgery residents provided primary palliative care and engaged specialty palliative care services. DESIGN Phase I consisted of a previously validated survey instrument supplemented with additional questions. We then conducted semistructured interviews with a subset of the survey respondents (Phase II). Using thematic analysis, we characterized surgery residents' perceptions of palliative care delivery among surgical patients. SETTING General surgery residency programs across the state of Michigan. PARTICIPANTS General surgery residents across the state of Michigan. All residents in participating programs were invited to complete the survey in Phase I. Phase II consisted of a subset of the survey respondents who underwent semistructured interviews. Interview respondents were sampled to reflect the overall surveyed group. RESULTS Among 119 survey respondents (response rate 70%), all had encountered a palliative care specialist but only 58.8% had been taught when to consult or to refer to palliative care. Survey respondents reported on a multitude of barriers within the clinician, patient and family, and systemic domains. Interviews expanded on survey findings and 4 influential factors of palliative care delivery emerged: (1) Resident Education and Training; (2) Resident Attitudes Toward Palliative Care; (3) Knowledge of Palliative Care; and (4) Training within a Surgical Culture. CONCLUSIONS This study reveals how surgery resident training and experiences impact palliative and end-of-life care for surgical patients at teaching institutions. Knowledge of how and when residents are providing primary palliative care and engaging with palliative care services will inform future knowledge and behavioral interventions for trainees who often provide care for patients nearing the end of life.
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Affiliation(s)
- Pasithorn A Suwanabol
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - C Ann Vitous
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Chithra R Perumalswami
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Sylvia H Li
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Nicholas Raja
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Christina W Lee
- Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Jane Forman
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management, Ann Arbor Veterans Affairs Health, Ann Arbor, Michigan
| | - Maria J Silveira
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Downar J. Resources for Educating, Training, and Mentoring All Physicians Providing Palliative Care. J Palliat Med 2020; 21:S57-S62. [PMID: 29283871 DOI: 10.1089/jpm.2017.0396] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article presents a rapid review of the published literature and available resources for educating Canadian physicians to provide palliative and end-of-life care. Several key messages emerge from the review. First, there are many palliative care educational resources already available for Canadian physicians. Second, the many palliative care education resources are often not used in physician training. Third, we know that some palliative care educational interventions are inexpensive and scalable, while others are costly and time-consuming; we know very little about which palliative care educational interventions impact physician behavior and patient care. Fourth, two palliative care competency areas in particular can be readily taught: symptom management and communication skill (e.g., breaking bad news and advance care planning). Fifth, palliative care educational interventions are undermined by the "hidden curriculum" in medical education; interventions must be accompanied by continuing education and faculty development to create lasting change in physician behavior. Sixth, undergraduate and postgraduate medical training is shifting from a time-based training paradigm to competency-based training and evaluation. Seventh, virtually every physician in Canada should be able to provide basic palliative care; physicians in specialized areas of practice should receive palliative care education that is tailored to their area, rather than generic educational interventions. For each key message, one or more implications are provided, which can serve as recommendations for a framework to improve palliative care as a whole in Canada.
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Affiliation(s)
- James Downar
- Division of Palliative Care, Department of Family and Community Medicine and Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto , Toronto, Ontario, Canada
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Al-Drees O, AlHubail M, Elzubair AG. Palliative Care: Knowledge and Attitude among Saudi Residents, 2016. J Palliat Med 2019; 22:1401-1409. [DOI: 10.1089/jpm.2018.0437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ola Al-Drees
- Saudi Board of Family Medicine, Arab Board of Family Medicine, Alahsa, Saudia Arabia
| | - Maryam AlHubail
- Saudi Board of Family Medicine, Arab Board of Family Medicine, Alahsa, Saudia Arabia
| | - Ahmed Gasim Elzubair
- Dean Postgraduate College, University of Medical Sciences & Technology, Khartoum, Sudan
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Pannell SC, Laviana AA, Huen KH, Shelton JB, Kwan L, Bennett CJ, Lorenz KA, Bergman J. Advance Care Planning and Patient Preferences in a Feasibility Pilot Study to Improve End-of-Life Communication among Men with Metastatic Urological Malignancies. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Stephanie C. Pannell
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Aaron A. Laviana
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kathy H.Y. Huen
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jeremy B. Shelton
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Carol J. Bennett
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Karl A. Lorenz
- Stanford University School of Medicine, Palo Alto, California
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jonathan Bergman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Olive View-UCLA Medical Center, Sylmar, California
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Suwanabol PA, Kanters AE, Reichstein AC, Wancata LM, Dossett LA, Rivet EB, Silveira MJ, Morris AM. Characterizing the Role of U.S. Surgeons in the Provision of Palliative Care: A Systematic Review and Mixed-Methods Meta-Synthesis. J Pain Symptom Manage 2018; 55:1196-1215.e5. [PMID: 29221845 DOI: 10.1016/j.jpainsymman.2017.11.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/25/2022]
Abstract
CONTEXT The provision of palliative care varies appropriately by clinical factors such as patient age and severity of disease and also varies by provider practice and specialty. Surgical patients are persistently less likely to receive palliative care than their medical counterparts for reasons that are not clear. OBJECTIVES We sought to characterize surgeon-specific determinants of palliative care in seriously ill and dying patients. METHODS We performed a systematic review of the literature focused on surgery and palliative care within PubMed, CINAHL, EMBASE, Scopus, and Ovid Medline databases from January 1, 2000 through December 31, 2016 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quantitative and qualitative studies with primary data evaluating surgeons' attitudes, knowledge, and behaviors or experiences in care for seriously ill and dying patients were selected for full review by at least two study team members based on predefined inclusion criteria. Data were extracted based on a predetermined instrument and compared across studies using thematic analysis in a meta-synthesis of qualitative and quantitative findings. RESULTS A total of 2589 abstracts were identified and screened, and 35 articles (26 quantitative and nine qualitative) fulfilled criteria for full review. Among these, 17 articles explored practice and attitudes of surgeons regarding palliative and end-of-life care, 11 articles assessed training in palliative care, five characterized surgical decision making, one described behaviors of surgeons caring for seriously ill and dying patients, and one explicitly identified barriers to use of palliative care. Four major themes across studies affected receipt of palliative care for surgical patients: 1) surgeons' experience and knowledge, 2) surgeons' attitudes, 3) surgeons' preferences and decision making for treatment, and 4) perceived barriers. CONCLUSIONS Among the articles reviewed, surgeons overall demonstrated insight into the benefits of palliative care but reported limited knowledge and comfort as well as a multitude of challenges to introducing palliative care to their patients. These findings indicate a need for wider implementation of strategies that allow optimal integration of palliative care with surgical decision making.
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Affiliation(s)
| | - Arielle E Kanters
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ari C Reichstein
- Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Lauren M Wancata
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily B Rivet
- Department of Surgery and Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Maria J Silveira
- Department of Surgery, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Arden M Morris
- S-SPIRE Center and Department of Surgery, Stanford University, Stanford, California, USA
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The effectiveness of online pain resources for health professionals: a systematic review with subset meta-analysis of educational intervention studies. Pain 2018; 159:631-643. [DOI: 10.1097/j.pain.0000000000001146] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Douma KFL, Aalfs CM, Dekker E, Tanis PJ, Smets EM. An E-Learning Module to Improve Nongenetic Health Professionals' Assessment of Colorectal Cancer Genetic Risk: Feasibility Study. JMIR MEDICAL EDUCATION 2017; 3:e24. [PMID: 29254907 PMCID: PMC5748476 DOI: 10.2196/mededu.7173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 07/27/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Nongenetic health providers may lack the relevant knowledge, experience, and communication skills to adequately detect familial colorectal cancer (CRC), despite a positive attitude toward the assessment of history of cancer in a family. Specific training may enable them to more optimally refer patients to genetic counseling. OBJECTIVE The aim of this study was to develop an e-learning module for gastroenterologists and surgeons (in training) aimed at improving attitudes, knowledge, and comprehension of communication skills, and to assess the feasibility of the e-learning module for continued medical education of these specialists. METHODS A focus group helped to inform the development of a training framework. The e-learning module was then developed, followed by a feasibility test among a group of surgeons-in-training (3rd- and 4th-year residents) and then among gastroenterologists, using pre- and posttest questionnaires. RESULTS A total of 124 surgeons-in-training and 14 gastroenterologists participated. The e-learning was positively received (7.5 on a scale of 1 to 10). Between pre- and posttest, attitude increased significantly on 6 out of the 10 items. Mean test score showed that knowledge and comprehension of communication skills improved significantly from 49% to 72% correct at pretest to 67% to 87% correct at posttest. CONCLUSIONS This study shows the feasibility of a problem-based e-learning module to help surgeons-in-training and gastroenterologists in recognizing a hereditary predisposition in patients with CRC. The e-learning led to improvements in attitude toward the assessment of cancer family history, knowledge on criteria for referral to genetic counseling for CRC, and comprehension of communication skills.
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Affiliation(s)
- Kirsten Freya Lea Douma
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Pieter J Tanis
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Ellen M Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Pan HH, Wu LF, Hung YC, Chu CM, Wang KY. Long-Term Effectiveness of Two Educational Methods on Knowledge, Attitude, and Practice Toward Palliative Care Consultation Services Among Nursing Staff: A Longitudinal Follow-Up Study. Clin Nurs Res 2017; 27:483-496. [PMID: 29228811 DOI: 10.1177/1054773817692082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This experimental study investigated long-term effectiveness of two educational methods on knowledge, attitude, and practice (KAP) about palliative care consultation services (PCCS) among nurses, recruited from a medical center located in Northern Taiwan in 2015, using a stratified cluster sampling method, with 88 participants in multimedia (experimental) and 92 in traditional paper education (control) group. Data were collected using KAP-PCCS questionnaire before education, immediately after, and 3rd and 6th month after education. Results showed that both K-PCCSI and P-PCCSI significantly increased immediately after, and at the 3rd month after education for the experimental group; the K-PCCSI remained significantly higher for the experimental group at the 6th month. The highest increase in scores for both K-PCCSI and P-PCCSI was observed at the 3rd month. There was no significant change in A-PCCS in both groups after follow-up periods, when compared before education. Therefore, using multimedia every 3 months to continue strengthening their knowledge may increase the referrals of terminal patients to PCCS.
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Affiliation(s)
| | - Li-Fen Wu
- 1 National Defense Medical Center, Taipei City, Taiwan.,2 Tri-Service General Hospital, Taipei City, Taiwan
| | - Yu-Chun Hung
- 1 National Defense Medical Center, Taipei City, Taiwan.,2 Tri-Service General Hospital, Taipei City, Taiwan
| | - Chi-Ming Chu
- 1 National Defense Medical Center, Taipei City, Taiwan
| | - Kwua-Yun Wang
- 1 National Defense Medical Center, Taipei City, Taiwan.,3 Taipei Veterans General Hospital, Taipei City, Taiwan.,4 National Yang-Ming University, Taipei City, Taiwan
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Walsh DW, McVey MC, Gass A, Zhang J, Mauldin PD, Rockey DC. Identification of high resource utilizing patients on internal medicine hospital services. J Investig Med 2016; 64:1172-8. [PMID: 27342424 DOI: 10.1136/jim-2016-000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 11/04/2022]
Abstract
In order to provide high quality, cost-efficient care, it is critical to understand drivers of the cost of care. Therefore, we sought to identify clinical variables associated with high utilization (cost) in patients admitted to medical services and to develop a robust model to identify high utilization patients. In this case-control analysis, cases were identified as the 200 most costly patients admitted to internal medicine/internal medicine subspecialty services using our institution's computerized clinical data warehouse over a 7-month time period (November 1, 2012-May 31, 2013). 400 patients admitted in the same time period were randomly selected to serve as controls. The mean cost for the highest utilization patients was $126,343, while that for randomly matched patients was $15,575. In a multivariable regression model, the following variables were associated with high utilization of resources: African American race, age 35-44, admission through the emergency department, primary service of hematology-oncology, a history of heart failure or paralysis, a diagnosis of HIV, cancer, collagen vascular diseases and/or coagulopathy, a reduced albumin, and/or an elevated creatinine. The in hospital mortality rate for high utilization patients was 19%, compared to 8% for controls (p=0.0002). A predictive model using 14 different readily available clinical variables predicted high utilization with an area under the curve of 0.85. The data suggest that high utilization patients share similar demographic and clinical features. We speculate that a predictive model using commonly known patient characteristics should be able to predict high utilization patients.
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Affiliation(s)
- David W Walsh
- Department of Internal Medicine, Division of General Internal Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Molly C McVey
- Department of Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA
| | - Abigal Gass
- Department of Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA
| | - Jingwen Zhang
- Department of Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA Division of General Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA
| | - Patrick D Mauldin
- Department of Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA Division of General Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA
| | - Don C Rockey
- Department of Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA
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Bergman J, Laviana AA. Opportunities to maximize value with integrated palliative care. J Multidiscip Healthc 2016; 9:219-26. [PMID: 27226721 PMCID: PMC4863682 DOI: 10.2147/jmdh.s90822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Palliative care involves aggressively addressing and treating psychosocial, spiritual, religious, and family concerns, as well as considering the overall psychosocial structures supporting a patient. The concept of integrated palliative care removes the either/or decision a patient needs to make: they need not decide if they want either aggressive chemotherapy from their oncologist or symptom-guided palliative care but rather they can be comanaged by several clinicians, including a palliative care clinician, to maximize the benefit to them. One common misconception about palliative care, and supportive care in general, is that it amounts to “doing nothing” or “giving up” on aggressive treatments for patients. Rather, palliative care involves very aggressive care, targeted at patient symptoms, quality-of-life, psychosocial needs, family needs, and others. Integrating palliative care into the care plan for individuals with advanced diseases does not necessarily imply that a patient must forego other treatment options, including those aimed at a cure, prolonging of life, or palliation. Implementing interventions to understand patient preferences and to ensure those preferences are addressed, including preferences related to palliative and supportive care, is vital in improving the patient-centeredness and value of surgical care. Given our aging population and the disproportionate cost of end-of-life care, this holds great hope in bending the cost curve of health care spending, ensuring patient-centeredness, and improving quality and value of care. Level 1 evidence supports this model, and it has been achieved in several settings; the next necessary step is to disseminate such models more broadly.
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Affiliation(s)
- Jonathan Bergman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Veterans Health Affairs-Greater Los Angeles, Los Angeles, CA, USA
| | - Aaron A Laviana
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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