1
|
Ladin K, Gazarian PK, Reich AJ, Weissman JS, Rodgers PE. Advance Care Planning: The Authors Reply. Health Aff (Millwood) 2022; 41:1061. [PMID: 35787075 DOI: 10.1377/hlthaff.2022.00617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Amanda J Reich
- Brigham and Women's Hospital and Harvard University Boston, Massachusetts
| | - Joel S Weissman
- Brigham and Women's Hospital and Harvard University Boston, Massachusetts
| | | |
Collapse
|
2
|
Ladin K, Bronzi OC, Gazarian PK, Perugini JM, Porteny T, Reich AJ, Rodgers PE, Perez S, Weissman JS. Understanding The Use Of Medicare Procedure Codes For Advance Care Planning: A National Qualitative Study. Health Aff (Millwood) 2022; 41:112-119. [PMID: 34982632 PMCID: PMC9683633 DOI: 10.1377/hlthaff.2021.00848] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In 2016 Medicare introduced advance care planning Current Procedural Terminology (CPT) codes to reimburse clinicians for time spent providing the service. Despite recent increases, use of these codes remains low for reasons incompletely captured by quantitative research. To further identify barriers and facilitators to code use for Medicare fee-for-service enrollees, we conducted case studies at eleven health systems, including 272 interviews with clinicians, administrators, and key leadership. Five themes related to use of the new codes emerged: code-based constraints to billing, burdening patients with unexpected charges, ethical concerns with billing for discussion of advance care plans, incentives to signal the importance of their use in billing, and increasing both workflow burden and the need for institutional supports and training. Respondents also observed that use was facilitated by health systems' investment in clinician training and in processes to audit the codes' use. Our findings suggest that increased reimbursement, strong institutional commitment and support, and streamlined workflow could improve the use of the new CPT codes to document receipt of and ensure access to Medicare advance care planning.
Collapse
Affiliation(s)
| | | | | | | | | | - Amanda J. Reich
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | |
Collapse
|
3
|
Gharzai LA, Griffith KA, Beeler WH, Burrows HL, Hammoud MM, Rodgers PE, Sabel MS, Carethers JM, Jagsi R. Speaker Introductions at Grand Rounds: Differences in Formality of Address by Gender and Specialty. J Womens Health (Larchmt) 2021; 31:202-209. [PMID: 34197213 DOI: 10.1089/jwh.2021.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Despite increasing representation of women in medicine, gender bias remains pervasive. The authors sought to evaluate speaker introductions by gender in the grand rounds of multiple specialties at a large academic institution to understand the cultural context of this behavior and identify predictors of formality. Materials and Methods: The authors reviewed grand rounds recordings of speakers with doctorates presenting to the departments of family medicine, general surgery, internal medicine, obstetrics and gynecology, and pediatrics at one institution from 2014 to 2019. The primary outcome was whether a speaker's professional title was used as the first form of address. The authors assessed factors correlated with professional introduction using multivariable logistic regression. Results: Speakers were introduced professionally in 346/615 recordings (56.3%). Female introducers were more likely to introduce speakers professionally (odds ratio [OR]: 2.52). A significant interaction existed between speaker gender and home institution: female speakers visiting from an external institution were less likely than male external speakers to be introduced professionally (OR: 0.49), whereas female speakers internal to the institution were more likely to be introduced professionally than male internal speakers (OR: 1.75). Use of professional titles varied by specialty and was higher than average for family medicine (83.2%), surgery (75.8%), and pediatrics (64.0%) and lower for internal medicine (37.5%) and obstetrics and gynecology (50.7%). Conclusions: These findings suggest a complex relationship between gender and formality of introduction that merits further investigation. Understanding differences in culture across specialties is important to inform efforts to promote equity.
Collapse
Affiliation(s)
- Laila A Gharzai
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kent A Griffith
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Whitney H Beeler
- Department of Radiation Oncology, Spectrum Healthcare Partners, Maine Medical Center, Portland, Maine, USA
| | - Heather L Burrows
- Department of Pediatrics and University of Michigan, Ann Arbor, Michigan, USA
| | - Maya M Hammoud
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Phillip E Rodgers
- Adult Palliative Care Clinical Programs, Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael S Sabel
- Department of Surgical Oncology and University of Michigan, Ann Arbor, Michigan, USA
| | - John M Carethers
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
4
|
Kamal AH, Thienprayoon RM, Aldridge M, Bull J, Fazzalaro K, Meier DE, Mueller L, Rodgers PE, McKenna KA, Pantilat SZ. Specialty Palliative Care in COVID-19: Early Experiences from the Palliative Care Quality Collaborative. J Palliat Med 2021; 24:1689-1696. [PMID: 34160293 DOI: 10.1089/jpm.2020.0440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: The COVID-19 pandemic has spurred unprecedented need for specialty palliative care. The Palliative Care Quality Collaborative (PCQC) provides unique infrastructure for rapid data collection and analysis. Objectives: To capture and describe real-time, real-world experiences of specialty palliative care professionals caring for patients with COVID-19 through a rapid reporting tool and registry. Setting: Palliative care clinicians consulted for patients either positive for COVID-19, under investigation for COVID-19, or recovered from COVID-19. Design: The PCQC created a 13-item COVID-19 case report form (CRF), modeled after the PCQC core dataset for specialty palliative care quality measurement. Twelve items offered discrete answer choices and one was open-ended. The CRF was publicized widely (e.g., social media, e-mail list serves) and completed through a link on the PCQC website. Results: Three hundred six reports (298 adult, 8 pediatric) were submitted between April 6, 2020 and October 7, 2020. The majority of patients (83%) were 50 years or older; 25% were 80 or older, and 78% were COVID-19 positive. Male gender identity was significantly more prevalent than female (58% vs. 40%, p < 0.002). The most common comorbidity was cardiovascular disease (23%). Of adult hospital-based patients, 69% were full code before palliative care consultation versus 28% after (p < 0.05). All pediatric patients were full code before and after palliative care consult. Qualitative themes were strained communication with patients, family visitation challenges, communication barriers between clinicians and families, rapid changes in palliative care medical management, community care options difficult to find, lack of testing in community-based settings, and guardianship and legal challenges. Conclusion: Preliminary data from the first 306 patients reported to the PCQC COVID-19 Registry describe palliative care use concentrated among older and higher risk patients and challenges to the provision of palliative care during this pandemic.
Collapse
Affiliation(s)
- Arif H Kamal
- Duke Cancer Institute and Duke Fuqua School of Business, Durham, North Carolina, USA
| | | | | | - Janet Bull
- Four Seasons, Hendersonville, North Carolina, USA
| | | | - Diane E Meier
- Mount Sinai School of Medicine, New York, New York, USA
| | - Lance Mueller
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Phillip E Rodgers
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly A McKenna
- Palliative Care Quality Collaborative, Chicago, Illinois, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
5
|
Rodgers PE. End-of-Life Care: Serious Illness Progression, Prognostication, and Advance Care Planning. FP Essent 2020; 498:21-25. [PMID: 33166103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Because of their longstanding relationships with patients, family physicians often are in the best position to identify signs of serious illness progression, provide support and guidance to patients and caregivers, and tailor care plans to individual needs and preferences at the end of life. Significant signs of illness progression include worsening of one or more conditions, decline in function, and increase in the number of emergency department visits or hospitalizations. Prognostication refers to estimation of the remaining life expectancy. Several tools are available to inform such estimates. Prognostication should include discussion of the expected illness progression to help patients and family members prepare, plan, and cope. Advance care planning, ideally started before or early in the course of illness, should include identification of patient surrogate decision-makers as well as a discussion of patient values, priorities, and care preferences. Planning should continue and evolve to inform care plans that match patient and family member priorities at each stage of illness. Family physicians should be familiar with resources available in their communities to support care plans, including palliative care subspecialists, home- and facility-based palliative care teams, and hospice physicians.
Collapse
Affiliation(s)
- Phillip E Rodgers
- University of Michigan - University Hospital South, F7890 UH South 1500 E. Medical Center Dr SPC 5233, Ann Arbor, MI 48109-5233
| |
Collapse
|
6
|
Rogers MM, Kamal AH, Rodgers PE, Meier DE, Pantilat SZ. Response to Bharadwaj et al., Challenges of Promoting Uniformity in Programs within a Health Care System (DOI: 10.1089/jpm.2019.0404). J Palliat Med 2020; 23:884-885. [PMID: 32196403 DOI: 10.1089/jpm.2020.0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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
| | - Arif H Kamal
- Duke Cancer Institute and the Fuqua School of Business, Duke University, Durham, North Carolina, USA
| | - Phillip E Rodgers
- Adult Palliative Medicine Program, Departments of Family Medicine and Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, 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
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
7
|
Smith MA, Quirk KC, Saul DC, Rodgers PE, Silveira MJ. Comparing Methadone Rotation to Consensus Opinion. J Pain Symptom Manage 2020; 59:116-120. [PMID: 31560968 DOI: 10.1016/j.jpainsymman.2019.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Methadone is a complex but useful medication for pain management in palliative care. Recent expert opinions have been published on the safe and effective use of methadone. OBJECTIVES To determine the success of methadone rotations and evaluate concordance with consensus recommendations by a palliative care consult service. METHODS A retrospective study of methadone rotation practice by a palliative care consult service and outcomes for patients hospitalized between January 1, 2012 and December 31, 2018 at a single academic medical center. A successful rotation was defined as a 30% reduction in pain or as-needed medication use sustained for at least three consecutive days. Patient outcomes were compared with expert consensus recommendations. RESULTS About 59 patients met the inclusion criteria. The study population was mostly Caucasian men and women of equal proportions who were started on methadone for inadequate pain control. Sixty-eight percent of patients were successfully rotated. Subjects who were rotated using a standardized protocol were six times more likely to have a successful rotation (odds ratio 6.28 [1.25-30.92]; P = 0.0238). CONCLUSION The utilization of a standardized protocol was associated with better patient outcomes.
Collapse
Affiliation(s)
- Michael A Smith
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan, USA; University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA.
| | - Kyle C Quirk
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan, USA; University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - D'Anna C Saul
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA; Department of Pediatrics, Ann Arbor, Michigan, USA
| | - Phillip E Rodgers
- Department of Family Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Maria J Silveira
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| |
Collapse
|
8
|
Kamal AH, Wolf SP, Troy J, Leff V, Dahlin C, Rotella JD, Handzo G, Rodgers PE, Myers ER. Policy Changes Key To Promoting Sustainability And Growth Of The Specialty Palliative Care Workforce. Health Aff (Millwood) 2019; 38:910-918. [DOI: 10.1377/hlthaff.2019.00018] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Arif H. Kamal
- Arif H. Kamal is an associate professor of medicine at Duke Cancer Institute, in Durham, North Carolina
| | - Steven P. Wolf
- Steven P. Wolf is a biostatistician at the Duke University School of Medicine, in Durham
| | - Jesse Troy
- Jesse Troy is an assistant professor in the Department of Pediatrics, Duke University School of Medicine
| | - Victoria Leff
- Victoria Leff is a palliative care social worker in the Section of Palliative Care at Duke University Hospital, in Durham
| | - Constance Dahlin
- Constance Dahlin is director of professional practice at the Hospice and Palliative Nurses Association, in Boston, Massachusetts
| | - Joseph D. Rotella
- Joseph D. Rotella is chief medical officer at the American Academy of Hospice and Palliative Medicine, in Chicago, Illinois
| | - George Handzo
- George Handzo is director of health services research and quality at the Healthcare Chaplaincy Network, in New York City
| | - Phillip E. Rodgers
- Phillip E. Rodgers is an associate professor of family medicine at the University of Michigan Medical School, in Ann Arbor
| | - Evan R. Myers
- Evan R. Myers is a professor of obstetrics and gynecology at the Duke University School of Medicine
| |
Collapse
|
9
|
Kamal AH, Wolf SP, Troy J, Leff V, Dahlin C, Rotella JD, Handzo G, Rodgers PE, Myers ER. Policy Changes Key To Promoting Sustainability And Growth Of The Specialty Palliative Care Workforce. Health Aff (Millwood) 2019. [DOI: 10.10.1377/hlthaff.2019.00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Arif H. Kamal
- Arif H. Kamal is an associate professor of medicine at Duke Cancer Institute, in Durham, North Carolina
| | - Steven P. Wolf
- Steven P. Wolf is a biostatistician at the Duke University School of Medicine, in Durham
| | - Jesse Troy
- Jesse Troy is an assistant professor in the Department of Pediatrics, Duke University School of Medicine
| | - Victoria Leff
- Victoria Leff is a palliative care social worker in the Section of Palliative Care at Duke University Hospital, in Durham
| | - Constance Dahlin
- Constance Dahlin is director of professional practice at the Hospice and Palliative Nurses Association, in Boston, Massachusetts
| | - Joseph D. Rotella
- Joseph D. Rotella is chief medical officer at the American Academy of Hospice and Palliative Medicine, in Chicago, Illinois
| | - George Handzo
- George Handzo is director of health services research and quality at the Healthcare Chaplaincy Network, in New York City
| | - Phillip E. Rodgers
- Phillip E. Rodgers is an associate professor of family medicine at the University of Michigan Medical School, in Ann Arbor
| | - Evan R. Myers
- Evan R. Myers is a professor of obstetrics and gynecology at the Duke University School of Medicine
| |
Collapse
|
10
|
Abstract
BACKGROUND Healthcare payment is rapidly evolving to reward value by measuring and paying for quality and spending performance. Rewarding value for the care of seriously ill patients presents unique challenges. OBJECTIVE To evaluate the state of current efforts to measure and reward value for the care of seriously ill patients. DESIGN We performed a PubMed search of articles related to (1) measures of spending for people with serious illness and (2) linking spending and quality measures and rewarding performance for the care of people with serious illness. We limited our search to U.S.-based studies published in English between January 1, 1960, and March 31, 2017. We supplemented this search by identifying public programs and other known initiatives that linked quality and spending for the seriously ill and extracted key program elements. RESULTS Our search related to linking spending and quality measures and rewarding performance for the care of people with serious illness yielded 277 articles. We identified three current public programs that currently link measures of quality and spending-or are likely to within the next few years-the Oncology Care Model; the Comprehensive End-Stage Renal Disease Model; and Home Health Value-Based Purchasing. Models that link quality and spending consist of four core components: (1) measuring quality, (2) measuring spending, (3) the payment adjustment model, and (4) the linking/incentive model. We found that current efforts to reward value for seriously ill patients are targeted for specific patient populations, do not broadly encourage the use of palliative care, and have not closely aligned quality and spending measures related to palliative care. CONCLUSIONS We develop recommendations for policymakers and stakeholders about how measures of spending and quality can be balanced in value-based payment programs.
Collapse
Affiliation(s)
- Andrew M Ryan
- 1 Department of Health Management and Policy, University of Michigan School of Public Health , Ann Arbor, Michigan.,2 Institute for Healthcare Policy and Innovation, University of Michigan , Ann Arbor, Michigan
| | - Phillip E Rodgers
- 2 Institute for Healthcare Policy and Innovation, University of Michigan , Ann Arbor, Michigan.,3 Department of Family Medicine, and Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School , Ann Arbor, Michigan
| |
Collapse
|
11
|
|
12
|
Abstract
BACKGROUND Dexmedetomidine is a potent α2-adrenergic agonist U.S. Food and Drug Administration (FDA) approved for sedation. While its use as an analgesic has been described in the palliative medicine literature, its use for managing an acute neuropathic pain episode is less well known. METHODS Here we describe the use of adjuvant dexmedetomidine in a patient with metastatic sarcoma suffering from an acute postoperative neuropathic pain crisis. CONCLUSION Among patients with acute neuropathic pain for whom additional opioids raises respiratory-related concerns, the use of dexmedetomidine should be considered as a viable treatment alternative.
Collapse
Affiliation(s)
- Thomas O'Neil
- Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | | | | |
Collapse
|
13
|
Vitale CA, Chandekar R, Rodgers PE, Pagani FD, Malani PN. A Call for Guidance in the Use of Left Ventricular Assist Devices in Older Adults. J Am Geriatr Soc 2012; 60:145-50. [DOI: 10.1111/j.1532-5415.2011.03740.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Rashmi Chandekar
- Division Infectious Diseases; Department of Internal Medicine; University of Michigan Health System; Ann Arbor; Michigan
| | - Phillip E. Rodgers
- Division of General Internal Medicine; Department of Internal Medicine; Virginia Commonwealth University Health System; Richmond; Virginia
| | | | | |
Collapse
|
14
|
Cinti SK, Barnosky AR, Gay SE, Goold SD, Lozon MM, Kim K, Rodgers PE, Baum NM, Cadwallender BA, Collins CD, Wright CM, Winfield RA. Bacterial pneumonias during an influenza pandemic: how will we allocate antibiotics? Biosecur Bioterror 2010; 7:311-6. [PMID: 19821750 DOI: 10.1089/bsp.2009.0019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We are currently in the midst of the 2009 H1N1 pandemic, and a second wave of flu in the fall and winter could lead to more hospitalizations for pneumonia. Recent pathologic and historic data from the 1918 influenza pandemic confirms that many, if not most, of the deaths in that pandemic were a result of secondary bacterial pneumonias. This means that a second wave of 2009 H1N1 pandemic influenza could result in a widespread shortage of antibiotics, making these medications a scarce resource. Recently, our University of Michigan Health System (UMHS) Scarce Resource Allocation Committee (SRAC) added antibiotics to a list of resources (including ventilators, antivirals, vaccines) that might become scarce during an influenza pandemic. In this article, we summarize the data on bacterial pneumonias during the 1918 influenza pandemic, discuss the possible impact of a pandemic on the University of Michigan Health System, and summarize our committee's guiding principles for allocating antibiotics during a pandemic.
Collapse
Affiliation(s)
- Sandro K Cinti
- Infectious Diseases, University of Michigan Hospitals/VA Ann Arbor Health Systems, Ann Arbor, Michigan 48105, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Chun ED, Rodgers PE, Vitale CA, Collins CD, Malani PN. Antimicrobial use among patients receiving palliative care consultation. Am J Hosp Palliat Care 2009; 27:261-5. [PMID: 19959846 DOI: 10.1177/1049909109352336] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We sought to characterize antimicrobial use among patients receiving palliative care consultation. METHODS Retrospective review of patients seen by the Palliative Care Service at the University of Michigan Health System from January 2008 to May 2008. RESULTS Of 131 patients seen in consultation, 70 received antimicrobials. We identified 92 infections among these 70 patients; therapy for 54 (58.7%) was empiric. Empiric therapy was most commonly prescribed for respiratory infection and urinary tract infection. Piperacillin/tazobactam (P/T) was the most frequently used agent, with 26 patients receiving P/T (37.1%); 22 of 26 received this agent empirically (84.6%, P = .005). Vancomycin was prescribed to 23 patients (32.9%). Sixteen patients (22.9%) died in hospital; another 31 were enrolled in hospice care. CONCLUSIONS Our results suggest significant use of empiric, broad-spectrum antimicrobial therapy among hospitalized patients near the end of life. We advocate for careful assessment of potential benefits and treatment burdens of antimicrobial therapy, especially when palliation is the goal.
Collapse
Affiliation(s)
- Erin Diviney Chun
- Department of Internal Medicine, Division of Geriatric Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | | | | | | | | |
Collapse
|
16
|
Spencer DC, Rodgers PE. Clinical inquiries. Are antibiotics effective for travelers' diarrhea? J Fam Pract 2001; 50:495-496. [PMID: 11401734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- D C Spencer
- University of North Carolina, Chapel Hill, USA
| | | |
Collapse
|
17
|
Rodgers PE, Boase DL. Spinal arachnoiditis in Jamaica. W INDIAN MED J 1977; 26:219-32. [PMID: 595584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|