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Zhang Z, Subramaniam DS, Howard SW, Johnston KJ, Frick WH, Enard K, Hinyard L. Use of Palliative Care Among Adults With Newly Diagnosed Heart Failure: Insights From a US National Insured Patient Sample. J Am Heart Assoc 2024; 13:e035459. [PMID: 39206718 DOI: 10.1161/jaha.124.035459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Despite the known benefits for individuals with heart failure (HF), incomplete data suggest a low use of palliative care (PC) for HF in the United States. We aimed to investigate the national PC use for adults with HF by determining when they received their first PC consultation (PCC) and the associations with clinical factors following diagnosis of HF. METHODS AND RESULTS We conducted a retrospective cohort study in a national all-payer electronic health record database to identify adults (aged ≥18 years) with newly diagnosed HF between 2011 and 2018. The proportion of those who received PCC within 5 years following a diagnosis of HF, and associations of time to first PCC with patient characteristics and HF-specific clinical markers were determined. We followed 127 712 patients for a median of 792 days, of whom 18.3% received PCC in 5 years. Shorter time to receive PCC was associated with diagnoses of HF in 2016 to 2018 (compared with 2010-2015: adjusted hazard ratio [aHR], 1.421 [95% CI, 1.370-1.475]), advanced HF (aHR, 2.065 [95% CI, 1.940-2.198]), cardiogenic shock (aHR, 2.587 [95% CI, 2.414-2.773]), implantable cardioverter-defibrillator (aHR, 5.718 [95% CI, 5.327-6.138]), and visits at academic medical centers (aHR, 1.439 [95% CI, 1.381-1.500]). CONCLUSIONS Despite an expanded definition of PC and recommendations by professional societies, PC for HF remains low in the United States. Racial and geographic variations in access and use of PC exist for patients with HF. Future studies should interrogate the mechanisms of PC underusage, especially before advanced stages, and address barriers to PC services across the health care system.
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Affiliation(s)
- Zidong Zhang
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine St. Louis MO USA
| | - Divya S Subramaniam
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine St. Louis MO USA
- Department of Health & Clinical Outcomes Research Saint Louis University School of Medicine St. Louis MO USA
| | | | | | - William H Frick
- Division of Cardiology, Department of Internal Medicine Saint Louis University School of Medicine St. Louis MO USA
| | - Kimberly Enard
- Department of Health Management and Policy, College for Public Health and Social Justice Saint Louis University St. Louis MO USA
| | - Leslie Hinyard
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine St. Louis MO USA
- Department of Health & Clinical Outcomes Research Saint Louis University School of Medicine St. Louis MO USA
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2
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Xie Z, Chen G, Oladeru OT, Hamadi HY, Montgomery L, Robinson MT, Hong YR. Inpatient Palliative Care and Healthcare Utilization Among Older Patients With Alzheimer's Disease and Related Dementia (ADRD) and High Risk of Mortality in U.S. Hospitals. Am J Hosp Palliat Care 2024:10499091241252685. [PMID: 38710104 DOI: 10.1177/10499091241252685] [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: 05/08/2024] Open
Abstract
Background. Despite the potential of palliative care (PC) to enhance the quality of life for patients with advanced dementia, there is limited knowledge of its inpatient utilization patterns. This study investigated inpatient PC consultation utilization patterns and evaluated its impact on hospital length of stay (LOS) and medical costs among older patients diagnosed with Alzheimer's Disease and Related Dementia who were at a high risk of mortality (ADRD-HRM). Methods. Using the 2016-2019 National Inpatient Sample database, we conducted multivariable logistic regression analyses to identify individual and hospital characteristics influencing PC consultation utilization. We subsequently performed generalized linear models to estimate LOS (using Poisson distribution) and hospital charges (via log-transformation). Results. Our sample encompassed 965,644 hospital discharges (weighted n = 4,828,219) of patients aged 65 years and above with ADRD-HRM. Among them, 14.6% received inpatient PC. There was a notable uptrend in PC consultation utilization from 13.3% in 2016 to 16.3% in 2019 (p trend<.001). Factors positively influencing and associated with PC utilization included patients that are older, non-Hispanic White, with higher income, receiving care from teaching hospitals, and facilitated with greater bed capacity (all P < .05). Although patients who received PC were more likely to have 3.0% longer LOS (P < .001), they had 19.2% lower hospital charges (P < .001). Conclusions. PC substantially reduced hospital expenditures for older patients with ADRD-HRM, but the prevalence remained low at 14.6% in the study period. Future studies should explore the unmet needs of patients with lower sociodemographic status and those in rural hospitals to further increase their PC consultation utilization.
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Affiliation(s)
- Zhigang Xie
- Department of Public Health, University of North Florida, Jacksonville, FL, USA
| | - Guanming Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Hanadi Y Hamadi
- Department of Health Administration, University of North Florida, Jacksonville, FL, USA
| | - Lucinda Montgomery
- Department of Public Health, University of North Florida, Jacksonville, FL, USA
| | | | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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3
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Olanipekun T, Sanghavi D, Moreno Franco P, Robinson MT, Thomas M, Kiley S, Paghdar S, Sareyyupoglu B, Diaz Milian R. Translating Policy to Practice: An Association Between Medicare Access and Children's Health Insurance Program Reauthorization Act Implementation and Palliative Care Consultations and Perioperative Mortality in Critical Care. Crit Care Med 2023; 51:1461-1468. [PMID: 37378470 DOI: 10.1097/ccm.0000000000005982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
OBJECTIVES To evaluate the 30-day postoperative mortality and palliative care consultations in patients that underwent surgical procedures in the United States before and after Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA) implementation. DESIGN Retrospective, Observational cohort study. SETTING Secondary data were collected from the U.S. National Inpatient Sample, the largest hospital database in the country. The time span was from 2011 to 2019. PATIENTS Adult patients that electively underwent 1 of 19 major procedures. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was cumulative postoperative mortality in two study cohorts. The secondary outcome was palliative care use. We identified 4,900,451 patients and categorized them into two study cohorts: PreM: 2011-2014 ( n = 2,103,836) and PostM: 2016-2019 ( n = 2,796,615). Regression discontinuity estimates and multivariate analysis were used. Across all procedures, 149,372 patients (7.1%) and 156,610 patients (5%) died within 30 days of their index procedures in the PreM and PostM cohorts, respectively. There was no statistically significant increase in mortality rates around postoperative day (POD) 30 (POD 26-30 vs 31-35) for both cohorts. More patients had inpatient palliative consultations during POD 31-60 compared with POD 1-30 in PreM (8,533 of 2,081,207 patients [0.4%] vs 1,118 of 22,629 patients [4.9%]) and PostM (18,915 of 2,791,712 patients [0.7%] vs 417 of 4,903 patients [8.5%]). Patients were more likely to receive palliative care consultations during POD 31-60 compared with POD 1-30 in both the PreM (odds ratio [OR] 5.31; 95% CI, 2.22-8.68; p < 0.001) and the PostM (OR 7.84; 95% CI, 4.83-9.10; p < 0.001) cohorts. CONCLUSIONS We did not observe an increase in postoperative mortality after POD 30 before or after MACRA implementation. However, palliative care use markedly increased after POD 30. These findings should be considered hypothesis-generating because of several confounders.
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Affiliation(s)
- Titilope Olanipekun
- Safety, Quality, Informatics and Leadership Program, Department of Postgraduate Medical Education, Harvard Medical School, Boston, MA
- Department of Hospital Medicine, Covenant Health System, Knoxville, TN
| | - Devang Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Maisha T Robinson
- Department of Neurology, Family Medicine, Palliative Medicine, Mayo Clinic, Jacksonville, FL
| | - Mathew Thomas
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Jacksonville, FL
| | - Sean Kiley
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Smit Paghdar
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Basar Sareyyupoglu
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Jacksonville, FL
| | - Ricardo Diaz Milian
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
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4
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Parker MM. Quality Improvement or Unintended Consequences? Crit Care Med 2023; 51:1589-1591. [PMID: 37902342 DOI: 10.1097/ccm.0000000000006009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- Margaret M Parker
- Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
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5
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Frydman JL, Gelfman LP. "Dose" of Palliative Care Matters: Let's Figure Out How to Measure It Nationally. J Palliat Med 2023; 26:1040-1041. [PMID: 37579233 DOI: 10.1089/jpm.2023.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Julia L Frydman
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura P Gelfman
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, New York City, New York, USA
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6
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Wilson PM, Ramar P, Philpot LM, Soleimani J, Ebbert JO, Storlie CB, Morgan AA, Schaeferle GM, Asai SW, Herasevich V, Pickering BW, Tiong IC, Olson EA, Karow JC, Pinevich Y, Strand J. Effect of an Artificial Intelligence Decision Support Tool on Palliative Care Referral in Hospitalized Patients: A Randomized Clinical Trial. J Pain Symptom Manage 2023; 66:24-32. [PMID: 36842541 DOI: 10.1016/j.jpainsymman.2023.02.317] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/26/2023]
Abstract
CONTEXT Palliative care services are commonly provided to hospitalized patients, but accurately predicting who needs them remains a challenge. OBJECTIVES To assess the effectiveness on clinical outcomes of an artificial intelligence (AI)/machine learning (ML) decision support tool for predicting patient need for palliative care services in the hospital. METHODS The study design was a pragmatic, cluster-randomized, stepped-wedge clinical trial in 12 nursing units at two hospitals over a 15-month period between August 19, 2019, and November 17, 2020. Eligible patients were randomly assigned to either a medical service consultation recommendation triggered by an AI/ML tool predicting the need for palliative care services or usual care. The primary outcome was palliative care consultation note. Secondary outcomes included: hospital readmissions, length of stay, transfer to intensive care and palliative care consultation note by unit. RESULTS A total of 3183 patient hospitalizations were enrolled. Of eligible patients, A total of 2544 patients were randomized to the decision support tool (1212; 48%) and usual care (1332; 52%). Of these, 1717 patients (67%) were retained for analyses. Patients randomized to the intervention had a statistically significant higher incidence rate of palliative care consultation compared to the control group (IRR, 1.44 [95% CI, 1.11-1.92]). Exploratory evidence suggested that the decision support tool group reduced 60-day and 90-day hospital readmissions (OR, 0.75 [95% CI, 0.57, 0.97]) and (OR, 0.72 [95% CI, 0.55-0.93]) respectively. CONCLUSION A decision support tool integrated into palliative care practice and leveraging AI/ML demonstrated an increased palliative care consultation rate among hospitalized patients and reductions in hospitalizations.
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Affiliation(s)
- Patrick M Wilson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.M.W, J.O.E., C.B.S., G.M.S.), Rochester, Minnesota, USA.
| | - Priya Ramar
- Department of Medicine (P.R., L.M.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Lindsey M Philpot
- Department of Medicine (P.R., L.M.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Jalal Soleimani
- Department of Anesthesiology (J.S., V.H., B.W.P., Y.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Jon O Ebbert
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.M.W, J.O.E., C.B.S., G.M.S.), Rochester, Minnesota, USA; Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| | - Curtis B Storlie
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.M.W, J.O.E., C.B.S., G.M.S.), Rochester, Minnesota, USA; Department of Health Sciences Research (C.B.S.), Mayo Clinic, Rochester, Minnesota, USA
| | - Alisha A Morgan
- Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| | - Gavin M Schaeferle
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.M.W, J.O.E., C.B.S., G.M.S.), Rochester, Minnesota, USA
| | - Shusaku W Asai
- Health Analytics | Global Health and Wellbeing (S.W.A.), Delta Air Lines, Atlanta, Georgia, USA
| | - Vitaly Herasevich
- Department of Anesthesiology (J.S., V.H., B.W.P., Y.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Brian W Pickering
- Department of Anesthesiology (J.S., V.H., B.W.P., Y.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Ing C Tiong
- Department of Information Technology (I.C.T.), Mayo Clinic, Rochester, Minnesota, USA
| | - Emily A Olson
- Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| | - Jordan C Karow
- Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
| | - Yuliya Pinevich
- Department of Anesthesiology (J.S., V.H., B.W.P., Y.P.), Mayo Clinic, Rochester, Minnesota USA
| | - Jacob Strand
- Division of Community Internal Medicine (J.O.E., A.A.M. E.A.O., J.C.K., J.S.), Geriatrics and Palliative Care Mayo Clinic, Rochester, Minnesota, USA
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Kim SJ, Patel I, Park C, Shin DY, Chang J. Palliative care and healthcare utilization among metastatic breast cancer patients in U.S. Hospitals. Sci Rep 2023; 13:4358. [PMID: 36928807 PMCID: PMC10020145 DOI: 10.1038/s41598-023-31404-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/11/2023] [Indexed: 03/18/2023] Open
Abstract
There is a lack of research focused on understanding the different characteristics and healthcare utilization of metastatic breast cancer patients by palliative care use. This study aims to investigate trend of in-patient palliative care and its association with healthcare utilization among hospitalized metastatic breast cancer patients in the US. National Inpatient Sample (NIS) was used to identify nationwide metastatic breast cancer patients (n = 5209, weighted n = 25,961) from 2010 to 2014. We examined the characteristics of the study sample by palliative care and its association with healthcare utilization, measured by discounted hospital charges and length of stay. Multivariable survey regression models were used to identify predictors. Among 26,961 breast cancer patients, 19.0% had palliative care. Percentage of receiving palliative care during the period were gradually increased. Social factors including race, insurance types were also associated with a receipt of palliative care. Survey linear regression results showed that patients with palliative care were associated with 31% lower hospital charges, however, length of stays were not significantly associated. This study found evidence of who was associated with the receipt of palliative care and its relationship with healthcare utilization. This study also emphasizes the importance of receiving palliative care in patients with breast cancer, paving the way for future research into ways to improve palliative care in cancer patients. This study also found social differences and gave evidence of programs that could be used to help vulnerable groups in future health policy decisions.
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Affiliation(s)
- Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea
- Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea
- Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea
| | - Isha Patel
- Department of Health Care Management, Brad D. Smith School of Business, Marshall University, Huntington, WV, USA
| | - Chanhyun Park
- Health Outcomes and Pharmacy Practice, College of Pharmacy, University of Texas, Austin, TX, USA
| | - Dong Yeong Shin
- Department of Public Health Sciences, College of Health, Education and Social Transformation, New Mexico State University, Las Cruces, NM, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, 77843, USA.
- Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, 77843, USA.
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8
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Humphrey L. The Have and Have Nots: Characteristics of Hospitals With a Pediatric Palliative Care Program. Pediatrics 2022; 150:189473. [PMID: 36093618 DOI: 10.1542/peds.2022-058233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lisa Humphrey
- Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University School of Medicine, Columbus, Ohio
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9
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Weaver MS, Shostrom VK, Kaye EC, Keegan A, Lindley LC. Palliative Care Programs in Children's Hospitals. Pediatrics 2022; 150:189474. [PMID: 36093621 DOI: 10.1542/peds.2022-057872] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUNG AND OBJECTIVES This study determined the prevalence of PPC programs in the United States and compared the environment of children's hospitals with and without PPC programs. METHODS Analyses of the multicenter Children's Hospital Association Annual Benchmark Report 2020 survey for prevalence of PPC programs and association with operational, missional, educational, and financial domains. RESULTS Two hundred thirty-one hospitals received Annual Benchmark Report survey requests with 148 submitted (64% response rate) inclusive of 50 states. One hundred nineteen (80%) reported having a PPC program and 29 (20%) reported not having a PPC program. Free-standing children's hospitals (n = 42 of 148, 28%) were more likely to report the presence of PPC (P = .004). For settings with PPC programs, the median number of staffed beds was 185 (25th quartile 119, 75th quartile 303) compared with 49 median number of staffed beds for those without PPC (25th quartile 30, 75th quartile 81). Facilities with higher ratio of trauma, intensive care, or acuity level were more likely to offer PPC. Although palliative care was associated with hospice (P <.001) and respite (P = .0098), over half of facilities reported not having access to hospice for children (n = 82 of 148, 55%) and 79% reported not having access to respite care (n = 117 of 148). CONCLUSIONS PPC, hospice, and respite services remain unrealized for many children and families in the United States. Programmatic focus and advocacy efforts must emphasize creation and sustainability of quality PPC programs in smaller, lower resourced hospitals.
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Affiliation(s)
- Meaghann S Weaver
- Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska.,National Center for Ethics in Healthcare, Washington, District of Columbia
| | - Valerie K Shostrom
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Erica C Kaye
- St Jude Children's Research Hospital, Memphis, Tennessee
| | - Amy Keegan
- Children's Hospital Association, Lenexa, Kansas
| | - Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, Knoxville, Tennessee
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10
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Hauser J. What palliative care physicians wish neurologists knew. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:85-92. [PMID: 36055722 DOI: 10.1016/b978-0-323-85029-2.00013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This chapter describes several features of palliative care that we believe can assist neurologists in caring for patients with serious illness. These features include the importance of recognizing suffering, the central of total pain (including physical, emotional, spiritual, and existential aspects), structural features of palliative care such as the distinction been palliative care and hospice, and the concept of primary and specialty palliative care. Structural features of palliative care such as interdisciplinary teamwork, approaches to self-care, and a perspective on prognostic uncertainty are also considered. Throughout this chapter, the focus is on ways in which neurologists can integrate these approaches in caring for patients and their families.
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Affiliation(s)
- Joshua Hauser
- Department of Medicine, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, IL, United States; Department of Medicine, Jesse Brown VA Medical Center, Northwestern University, Chicago, IL, United States.
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11
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Nandwani J, Maguire JM, Rogers M, Meier DE, Kamal AH. Palliative Care Specialist Access is Associated With Rankings of Hospital Quality. J Pain Symptom Manage 2021; 62:149-152. [PMID: 33607209 DOI: 10.1016/j.jpainsymman.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
CONTEXT Increasing evidence has shown that access to specialty palliative care, particularly outpatient palliative care clinics, can yield improved health outcomes and be a marker of hospital quality. OBJECTIVE To determine whether an association exists between access to specialty palliative care programs and hospital rankings found in the 2020-2021 U.S. News & World Report Best Hospitals. METHODS This study used publicly available data from the Center to Advance Palliative Care (CAPC) Provider Directory to determine access to in-patient and out-patient palliative care in the 2020-2021 U.S. News & World Report Best Hospitals Rankings. Descriptive statistics and chi-squares were performed. Data were also analyzed across the four U.S. Census Bureau regions (Northeast, South, Midwest, West). RESULTS Around 100% of the Top 20 hospitals include hospital-based palliative care consultation teams, and 95% offered outpatient palliative care. Of the second cohort of 83 hospitals, 99% offered inpatient palliative care, and 65% offered outpatient palliative care. Of the third cohort of 75 hospitals ranked, 96% had inpatient palliative care services, while only 41.3% offered outpatient palliative care. This represents a significant association between rank position and access to outpatient palliative care (P < 0.01). Ranked hospitals also have significantly higher access to hospital-based palliative care teams compared to the national prevalence rate (P < 0.01). CONCLUSION These findings reflect the association of access to specialty palliative care with USNWR rankings for hospital quality. Further study is necessary to determine the specific influence of access to palliative care and USNWR rank position.
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Affiliation(s)
- Jaan Nandwani
- Trinity College of Arts and Sciences, Duke University, Durham, North Carolina
| | | | - Maggie Rogers
- Center to Advance Palliative Care, New York, New York
| | - Diane E Meier
- Center to Advance Palliative Care, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arif H Kamal
- Duke Cancer Institute, Duke University, Durham, North Carolina; Duke Fuqua School of Business, Duke University, Durham, North Carolina.
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12
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Langan E, Kamal AH, Miller KEM, Kaufman BG. Comparing Palliative Care Knowledge in Metropolitan and Nonmetropolitan Areas of the United States: Results from a National Survey. J Palliat Med 2021; 24:1833-1839. [PMID: 34061644 DOI: 10.1089/jpm.2021.0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Despite recent growth in access to specialty palliative care (PC) services, awareness of PC by patients and caregivers is limited and misconceptions about PC persist. Identifying gaps in PC knowledge may help inform initiatives that seek to reduce inequities in access to PC in rural areas. Objective: We compared knowledge of PC in metropolitan and nonmetropolitan areas of the United States using a nationally representative sample of U.S. adults. Design: We used data from the 2018 Health Information National Trends Survey (HINTS) 5 Cycle 2 to compare prevalence and predictors of PC knowledge and misconceptions in nonmetropolitan and metropolitan areas as defined by the 2013 Urban-Rural Classification (URC) Scheme for Counties. We estimated the association between nonmetro status and knowledge of PC, adjusted for respondent characteristics, using multivariable logistic regression. Results: More respondents reported that they had never heard of PC in nonmetro (78.8%) than metro (70.1%) areas (p < 0.05). Controlling for other factors, nonmetro residence was associated with a 41% lower odds of PC knowledge (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.37-0.94), and Hispanic respondents also demonstrated significantly lower odds of PC knowledge conditional on rural status (OR = 0.47; CI = 0.27-0.83). Misconceptions about PC were high in both metro and nonmetro areas. Conclusion: Awareness of PC was lower in rural and micropolitan areas compared with metropolitan areas, suggesting the need for tailored educational strategies. The reduced awareness of PC among Hispanic respondents regardless of rural status raises concerns about equitable access to PC services for this population.
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Affiliation(s)
- Erica Langan
- Trinity College of Arts and Sciences, Duke University, Durham, North Carolina, USA
| | - Arif H Kamal
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine E M Miller
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
| | - Brystana G Kaufman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
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13
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Rogers MM, Meier DE, Morrison RS, Moreno J, Aldridge M. Factors Associated with the Adoption and Closure of Hospital Palliative Care Programs in the United States. J Palliat Med 2021; 24:712-718. [PMID: 33058737 PMCID: PMC8064954 DOI: 10.1089/jpm.2020.0282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background: In the United States, the percentage of hospitals over 50 beds with palliative care programs has risen substantially from 7% of hospitals in 2001 to 72% in 2017. Yet the dynamic nature of program adoption and closure over time is not known. Objective: To examine the rate of palliative care program adoption and closure and associated hospital and geographic characteristics in a national sample of U.S. hospitals. Design: Adoption and closure rates were calculated for 3696 U.S. hospitals between 2009 and 2017. We used multivariable logistic regression models to examine the association between adoption and closure status and hospital, geographic, and community characteristics. Setting/Subjects: All nonfederal general medical and surgical, cancer, heart, and obstetric or gynecological hospitals, of all sizes, in the United States in operation in both 2009 and 2017. Results: By 2017, 34.9% (812/2327) of the hospitals without palliative care in 2009 had adopted palliative care programs, and 15.0% (205/1369) of the hospitals with programs had closed them. In multivariable models, hospitals in metropolitan areas, nonprofit and public hospitals (compared to for-profit hospitals), and those with residency training approval by the Accreditation Council for Graduate Medical Education were significantly more likely to adopt and significantly less likely to close palliative care programs during the study period. Conclusions: This study indicates that palliative care is not equitably adopted nor sustained by hospitals in the United States. Federal and state interventions may be required to ensure that high-quality care is available to our nation's sickest patients.
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Affiliation(s)
- Maggie M. Rogers
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diane E. Meier
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - R. Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters VA Medical Center, Bronx, New York, USA
| | - Jaison Moreno
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters VA Medical Center, Bronx, New York, USA
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Rogers MM, Chambers B, Esch A, Meier DE, Bowman B. Use of an Online Palliative Care Clinical Curriculum to Train U.S. Hospital Staff: 2015-2019. J Palliat Med 2020; 24:488-495. [PMID: 33306934 DOI: 10.1089/jpm.2020.0514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Most clinicians in the United States do not receive pre-professional education in pain and symptom management, communication skills, and caregiver support. The use of these skills by clinicians improves the quality of care for persons living with serious illness and enables the specialty-trained palliative care workforce to focus on patients whose needs are most complex. Objective: To review current trends in hospital use of the Center to Advance Palliative Care (CAPC) online clinical training curriculum. Description: Launched in 2015, CAPC clinical curriculum educates clinicians in the knowledge and skills necessary to improve care for patients with serious illness. CAPC currently offers 43 clinical courses and 4 Designations in recognition of successful completion of training by topic. Results: From January 15, 2015, to August 31, 2019, 26,535 clinicians working in hospitals completed 172,684 clinical courses. Registered nurses represented half of learners, and advanced practice providers were most likely to seek Designation. Physicians made up 22% of all learners; 85% of physician learners came from specialties beyond palliative care. Two of every five U.S. hospitals with more than 300 beds had at least one learner. In post-course evaluations, 84% reported that they will make practice changes as a result, and 70% reported that the content was new. Conclusions: The CAPC clinical curriculum is a widely used and valued method for education in clinical skills specific to the care of people living with serious illness. Findings suggest that an increasing number of hospital leaders recognize the importance of these skills in caring for patients with serious illness and support the necessary training.
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Affiliation(s)
- Maggie M Rogers
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brittany Chambers
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew Esch
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diane E Meier
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brynn Bowman
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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