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  • 刊频： Monthly, 2009-
  • NLM标题： J Palliat Med
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  • 1.

    【2hr】Increased Symptom Expression among Patients with Delirium Admitted to an Acute Palliative Care Unit

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    机译 急性姑息治疗病房的Deli妄患者的症状表达增加
    摘要：Introduction: Delirium is the most common neuropsychiatric condition in very ill patients and those at the end of life. Previous case reports found that delirium-induced disinhibition may lead to overexpression of symptoms. It negatively affects communication between patients, family members, and the medical team and can sometimes lead to inappropriate interventions. Better understanding would result in improved care. Our aim was to determine the effect of delirium on the reporting of symptom severity in patients with advanced cancer.Methods: We reviewed 329 consecutive patients admitted to the acute palliative care unit (APCU) without a diagnosis of delirium from January to December 2011. Demographics, Memorial Delirium Assessment Scale, Eastern Cooperative Oncology Group (ECOG) Performance status, and Edmonton Symptom Assessment Scale (ESAS) on two time points were collected. The first time point was on admission and the second time point for group A was day one (+two days) of delirium. For group B, the second time point was within two to four days before discharge from the APCU. Patients who developed delirium and those who did not develop delirium during the entire course of admission were compared using chi-squared test and Wilcoxon rank-sum test. Paired t-test was used to assess if the change of ESAS from baseline to follow-up was associated with delirium.Results: Ninety-six of 329 (29%) patients developed delirium during their admission to the APCU. The median time to delirium was two days. There was no difference in the length of stay in the APCU for both groups. Patients who did not have delirium expressed improvement in all their symptoms, while those who developed delirium during hospitalization showed no improvement in physical symptoms and worsening in depression, anxiety, appetite, and well-being.Conclusion: Patients with delirium reported no improvement or worsening symptoms compared to patients without delirium. Screening for delirium is important in patients who continue to report worsening symptoms despite appropriate management.
  • 2.

    【2hr】Are Preferences for Aggressive Medical Treatment Associated with Healthcare Utilization in the Very Old?

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    机译 激进医疗的偏爱是否与很老的医疗保健利用相关联？
    摘要：Objectives: To examine the relationship between end-of-life (EOL) treatment preferences and recent hospitalization or emergency department (ED) care in the very old.Design: Quarterly telephone follow-up of participants in the EOL in the Very Old cohort.Setting: The EOL in the Very Old Age cohort drew from 1403 participants in the Health, Aging, and Body Composition (Health ABC) study who were alive in year 15 of follow-up. 87.5% (n = 1227) were successfully recontacted and enrolled.Participants: Preferences for treatment at the EOL and reported hospital and ED use were examined for 1118 participants (18% involving proxy reports) over 6 months, 1021 (16% with proxy reports) over 12 months, and 945 (23% with proxy reports) over 18 months in 6-month intervals.Measurements: Preferences for eight EOL treatments, elicited once each year; hospitalization and ED use reported every six months.Results: Preferences for more aggressive treatment (endorsing ≥5 of 8 options) were not significantly associated with inpatient or ED treatment. Inpatient and ED treatment were not associated with changes in preferences for aggressive EOL treatment over 12 months.Conclusion: Alternative measures that tap attitudes toward routine care, rather than EOL treatment preferences, may be more highly associated with healthcare utilization.
  • 3.

    【2hr】Not Illness Trajectory but Bayesian-Estimated Rate Model Should Be Appropriately Explained When Discussing Palliative Care in Heart Disease

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    机译 当讨论心脏病的姑息治疗时，不应适当地解释疾病轨迹，而应适当解释贝叶斯估计率模型
    摘要：
  • 4.

    【2hr】Research Priorities for Palliative Care for Older Adults with Advanced Chronic Kidney Disease

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    机译 晚期慢性肾脏病老年人的姑息治疗研究重点
    摘要：Older adults with advanced chronic kidney disease (CKD) often have multiple comorbid conditions, a high symptom burden, and limited life expectancy. There is mounting concern that the intensive patterns of care that many of these patients receive at the end of life are discordant with their values and preferences. The nephrology community has recognized that there are significant unmet palliative care needs in this population.In this article, we identify three broad areas of knowledge deficit where more evidence is needed to support the “best care possible” for this population: (1) what matters most to older adults with advanced CKD and their caregivers near the end of life; (2) how the nephrology community can best support older adults with advanced CKD to navigate complex treatment decisions throughout their illness; and (3) how the healthcare system should be reconfigured to promote patient- and family-centered care for older adults with advanced CKD.Research priorities include identifying opportunities for improving the end-of-life experience of older adults with CKD and their caregivers; developing and testing communication interventions before and during dialysis to ensure that treatment decisions reflect patients' preferences; and assessing the effectiveness of palliative care in improving quality of life for patients and caregivers, satisfaction with care, and aligning treatment decisions with patient goals and preferences.
  • 5.

    【2hr】Introduction to Series

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    机译 系列介绍
    摘要：
  • 6.

    【2hr】Utility of the “Surprise” Question in Predicting Survival among Older Patients with Acute Surgical Conditions

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    机译 “惊奇”问题在预测急性外科疾病老年患者存活率中的作用
    摘要：Background: The surprise question is a validated tool for identifying patients with increased risk of death within one year who could, therefore, benefit from palliative care. However, its utility in surgery is unknown.Objective: We sought to determine whether the surprise question predicted 12-month mortality in older emergency general surgery patients.Design: This was a prospective cohort study.Setting/Subjects: Emergency general surgery attendings and surgical residents in or beyond their third year of training at a single tertiary care academic hospital from January to July 2014.Measurements: Surgeons responded to the surprise question within 72 hours of evaluating patients, ≥65 years, hospitalized with an acute surgical condition. Patient data, including demographic and clinical characteristics, were extracted from the medical record. Mortality within 12 months of initial evaluation was determined by using Social Security death data.Results: Ten attending surgeons and 18 surgical residents provided 163 responses to the surprise question for 119 patients: 60% of responses were “No, I would not be surprised” and 40% were “Yes, I would be surprised.” A “No” response was associated with increased odds of death within 12 months in binary logistic regression (OR 4.8 [95% CI 2.1–11.1]).Conclusions: The surprise question is a valuable tool for identifying older patients with higher risk of death, and it may be a useful screening criterion for older emergency general surgery patients who would benefit from palliative care evaluation.
  • 7.

    【2hr】The Prevalence and Risks for Depression and Anxiety in Hospice Caregivers

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    机译 临终关怀者的抑郁症和焦虑症患病率和风险
    摘要：Background: Depression and anxiety are common concerns for hospice caregivers.Objective: This study looked at the prevalence and variables associated with hospice caregiver depression and anxiety, as well as the relationship between the two conditions.Subjects: We did a secondary analysis of preexisting data.Measurements: Measures included the PHQ-9 and GAD-7.Results: Nearly one-quarter of caregivers were moderately to severely depressed, and nearly one-third reported moderate to severe symptoms of anxiety. Risk factors for both depression and anxiety included younger age and poorer self-rated global health. Depression-specific risk factors included being married and caring for a patient with a diagnosis other than cancer. The sole anxiety-specific risk factor identified was geographic location, as caregivers living in the Southeast were found to have greater anxiety than those in the Midwest.Conclusion: Hospice providers' recognition of family caregivers as both coproviders and corecipients of care underscores the need to more fully assess and respond to depression and anxiety among caregivers.
  • 8.

    【2hr】Developing a Research Agenda for Integrating Palliative Care into Critical Care and Pulmonary Practice To Improve Patient and Family Outcomes

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    机译 制定将姑息治疗纳入重症监护和肺部治疗的研究议程，以改善患者和家庭的结果
    摘要：Background: Palliative care is a medical specialty and philosophy of care that focuses on reducing suffering among patients with serious illness and their family members, regardless of disease diagnosis or prognosis. As critical illness or moderate to severe pulmonary disease confers significant disease-related symptom burdens, palliative care and palliative care specialists can aid in reducing symptom burden and improving quality of life among these patients and their family members.Objective: The objective of this article is to review the existing gaps in evidence for palliative care in pulmonary disease and critical illness and to use an interdisciplinary working group convened by the National Institutes of Health and the National Palliative Care Research Center to develop a research agenda to address these gaps.Methods: We completed a narrative review of the literature concerning the integration of palliative care into pulmonary and/or critical care. The review was based on recent systematic reviews on these topics as well as a summary of relevant articles identified through hand search. We used this review to identify gaps in current knowledge and develop a research agenda for the future.Results: We identified key areas of need and knowledge gaps that should be addressed to improve palliative care for patients with pulmonary and critical illness. These areas include developing and validating patient- and family-centered outcomes, identifying the key components of palliative care that are effective and cost-effective, developing and evaluating different models of palliative care delivery, and determining the effectiveness and cost-effectiveness of palliative care interventions.Conclusions: The goal of this research agenda is to encourage researchers, clinicians, healthcare systems, and research funders to identify research that can address these gaps and improve the lives of patients with pulmonary and critical illness and their family members.
  • 9.

    【2hr】The Role of Advanced Practice Registered Nurses in the Completion of Physician Orders for Life-Sustaining Treatment

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    机译 高级执业注册护士在完成维持生命治疗的医师命令中的作用
    摘要：Background: The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm records advance care planning for patients with advanced illness or frailty as actionable medical records. The National POLST Paradigm Task Force recommends that physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs) be permitted to execute POLST forms.Objective: To investigate the percentage of Oregon POLST forms signed by APRNs, and examine the obstacles faced by states attempting to allow APRNs to sign POLST forms.Design: Cross-sectional.Setting/subjects: 226,101 Oregon POLST Registry forms from 2010 to 2015.Measurements: POLST forms in the Oregon Registry were matched with signer type (MD, DO, APRN, PA).Results: 226,101 POLST forms have been added to the Oregon POLST Registry from 2010 to 2015: 85.3% of forms were signed by a physician, 10.9% of forms were signed by an APRN, and 3.8% of forms were signed by a PA. From 2010 to 2015, the overall percentage of POLST forms signed by an APRN has increased from 9.0% in 2010 to 11.9% in 2015. Physicians are authorized signers in all 19 states with endorsed POLST Paradigm programs; 16 of these states also authorize APRN signature, and 3 states (LA, NY, and GA) allow only physicians to sign.Conclusions: More than 10% of Oregon POLST forms are signed by APRNs. Given the need for timely POLST form completion, ideally by a member of the interdisciplinary team who knows the patient's preferences best, these data support authorizing APRNs to complete POLST forms.
  • 10.

    【2hr】Validation of the V66.7 Code for Palliative Care Consultation in a Single Academic Medical Center

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    机译 在单个学术医学中心对姑息治疗咨询V66.7规范进行验证
    摘要：Background: Use of administrative data to study the effectiveness of specialized palliative care is limited by the lack of a reliable method to identify patients receiving palliative care consultation. The International Classification of Diseases, Ninth Revision (ICD-9) code V66.7 has been used, but its validity for this purpose is unknown.Objective: To examine the validity of the ICD-9 code V66.7 for identifying whether hospitalized patients received palliative care consultation.Design: Retrospective cohort study.Setting/Subjects: All patients of age ≥18 years admitted to a single academic medical center between August 2013 and August 2015.Measurements: Sensitivity and specificity of the V66.7 code for palliative care consultation for all patients and several a priori identified subgroups. The reference standard was the presence of a palliative care consultation note in the electronic medical record.Results: Of 100,910 admissions, 1999 received a palliative care consultation (2.0%) and 1846 (1.8%) had usage of the V66.7 code. Sensitivity and specificity for the V66.7 code were 49.9% and 99.1%, respectively. Sensitivity was considerably higher for certain subgroups, such as patients with dementia (76.3%) and metastatic cancer (66.3%); addition of age restrictions further improved sensitivity while maintaining high specificity. Specificity was substantially lower for patients who died during hospitalization (sensitivity 53.9%, specificity 75.1%).Conclusions: In a single center, the ICD-9 code V66.7 had poor sensitivity and high specificity for identifying hospitalized patients who received a palliative care consultation. Appropriate use of this code for this purpose should take these characteristics into consideration.
  • 11.

    【2hr】Preparing Older Adults with Serious Illness To Formulate Their Goals for Medical Care in the Emergency Department

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    机译 准备重病的老年人制定急诊科的医疗目标
    摘要：Background: Emergency department (ED) clinicians often lack training and resources to conduct advance care planning (ACP) conversations. The use of technology for health education is increasing, yet little is known if it can be used to engage older ED patients in ACP.Objective: To determine the feasibility of using tablets to provide ACP education ()(PREPARE) to older ED patients.Design: A feasibility study conducted in late 2014 and early 2015.Setting/Subjects: Subjects were recruited from a parent cohort of older adults enrolled in a survey about Geriatric ED care. Inclusion criteria were ≥65 years age and English speaking; exclusions were hearing or vision impairment or if clinically unstable.Measurements: Primary outcome was completion of ≥1 of 5 PREPARE modules. Secondary outcomes were ease of use (10-point scale; 1 = very hard, 10 = very easy) and the reasons for refusal to participate.Results: Sixty-one subjects were approached; 24 (39%) were interested in viewing PREPARE after the Geriatric ED survey. Mean age was 75 years (standard deviation [SD] 9); 67% were female and 54% were nonwhite. Seventy-one percent of participants completed ≥1 module. Participants rated the website as easy to use for themselves (mean 8.4, SD 2.39) and for others (mean 7.3, SD 2.31). Of the subjects who declined, top reasons cited were fatigue (26%), already feeling prepared (13%), and technology limitations (11%).Conclusion: PREPARE has the potential to engage older adults who are not acutely ill in ACP during their ED visits. Further studies should explore optimal approaches for ED implementation.
  • 12.

    【2hr】A Provider-Based Survey To Assess Bereavement Care Knowledge, Attitudes, and Practices in Pediatric Oncologists

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    机译 基于提供者的调查，评估儿科肿瘤科医生的丧亲护理知识，态度和做法
    摘要：Background: Bereavement support is a core tenet of palliative care that may prove difficult for clinicians as it is time-consuming, emotionally charged, and not emphasized in pediatrics training. This project is intended to describe the opinions, knowledge, and practice of bereavement care among pediatric oncologists to identify gaps in clinical care.Procedures: An internet-based survey instrument was pilot tested, refined, and distributed to pediatric oncologists in the United States. Statistical analysis was performed using SAS 9.2.Results: Electronic surveys were distributed to 2,061 pediatric oncologists and 522 surveys (25%) were fully completed. Participants were asked how likely they are to engage in particular bereavement activities (phone calls, condolence cards, memorial services, family meetings, or referrals for counseling) following the death of a pediatric cancer patient. Eighty-two percent of participants, at least, sometimes engage in at least one of these activities. Being female, an attending physician, and increased time in clinical practice were predictive of active participation in bereavement care. Nearly all participants (96%) believe that bereavement care is part of good clinical care, while 8% indicate that bereavement support is not their responsibility. Lack of time and resources were the biggest barriers to providing bereavement support.Conclusions: The majority of pediatric oncologists engage in clinical practices to support bereaved families. Lack of time and physical resources pose significant barriers to clinician's efforts. Additional supports should be explored to increase pediatric oncology physician uptake of bereavement care practices.
  • 13.

    【2hr】Events Leading to Hospital-Related Disenrollment of Home Hospice Patients: A Study of Primary Caregivers' Perspectives

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    机译 导致与医院相关的家庭临终关怀患者退伍的事件：主要护理人员的观点研究
    摘要：Background: Approximately 25% of hospice disenrollments in the United States occur as the result of hospitalization, which can lead to burdensome transitions and undesired care. Informal caregivers (e.g., spouses, children) play a critical role in caring for patients on home hospice. Research examining hospital-related disenrollment among these patients is limited.Objective: To understand the events surrounding the hospitalization of patients discharged from home hospice through the perspective of their informal caregivers.Design: Thirty-eight semistructured phone interviews with caregivers were conducted, and data regarding the events leading to hospitalization and hospice disenrollment were collected. Study data were analyzed by using qualitative methods.Setting/Subjects: Subjects included caregivers of 38 patients who received services from one not-for-profit home hospice organization in New York City. Participants were English speaking only.Measurements: Caregiver recordings were transcribed and analyzed by using content analysis.Results: Content analysis revealed four major themes contributing to hospitalization: (1) distressing/difficult-to-witness signs and symptoms, (2) needing palliative interventions not deliverable in the home setting, (3) preference to be cared for by nonhospice physicians or at a local hospital, and (4) caregivers not comfortable with the death of their care recipient at home. Over half of all caregivers called 911 before calling hospice.Conclusions: Our study provides insight into the events leading to hospitalization of home hospice patients from the caregivers' perspective. Further research is needed to quantify the drivers of hospitalization and to develop interventions that reduce utilization, while improving care for home hospice patients and their caregivers.
  • 14.

    【2hr】Assessing Preparatory Grief in Advanced Cancer Patients as an Independent Predictor of Distress in an American Population

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    机译 评估晚期癌症患者的预备悲痛作为美国人群痛苦的独立预测因子
    摘要：Background: Grief is a universal experience for patients living with a terminal illness, but it is not routinely measured. The Preparatory Grief in Advanced Cancer (PGAC) instrument has been used in Greece, but this is its first use in an American population with advanced cancer.Objective: Our aim was to use the PGAC instrument in an American population of advanced cancer patients to explore demographic, clinical, and psychological factors that may predict higher preparatory grief.Design: Subjects completed a single cross-sectional time point evaluation.Setting/Subjects: Fifty-three adult outpatients and inpatients with incurable solid malignancies from Chicago, IL.Measurements: Demographic and clinical information, the PGAC instrument, the Hospital Anxiety and Depression Scale (HADS), the distress thermometer (DT), the Edmonton Symptom Assessment Scale (ESAS), and a quality-of-life (QOL) 2-question scale.Results: The mean PGAC score was 26.9 (range 0–70) and was only correlated with DT in multivariate analysis.Conclusions: Preparatory grief was a common experience, and one-fourth of our sample participants had significant grief. Distress was the only independent factor (including psychological, physical, clinical, or demographic factors) correlated with higher preparatory grief scores.
  • 15.

    【2hr】The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization

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    机译 以家庭为基础的姑息治疗计划对问责医疗组织的影响
    摘要：Background: People with advanced illness usually want their healthcare where they live—at home—not in the hospital. Innovative models of palliative care that better meet the needs of seriously ill people at lower cost should be explored.Objectives: We evaluated the impact of a home-based palliative care (HBPC) program implemented within an Accountable Care Organization (ACO) on cost and resource utilization.Methods: This was a retrospective analysis to quantify cost savings associated with a HBPC program in a Medicare Shared Savings Program ACO where total cost of care is available. We studied 651 decedents; 82 enrolled in a HBPC program compared to 569 receiving usual care in three New York counties who died between October 1, 2014, and March 31, 2016. We also compared hospital admissions, ER visits, and hospice utilization rates in the final months of life.Results: The cost per patient during the final three months of life was $12,000 lower with HBPC than with usual care ($20,420 vs. $32,420; p = 0.0002); largely driven by a 35% reduction in Medicare Part A ($16,892 vs. $26,171; p = 0.0037). HBPC also resulted in a 37% reduction in Medicare Part B in the final three months of life compared to usual care ($3,114 vs. $4,913; p = 0.0008). Hospital admissions were reduced by 34% in the final month of life for patients enrolled in HBPC. The number of admissions per 1000 beneficiaries per year was 3073 with HBPC and 4640 with usual care (p = 0.0221). HBPC resulted in a 35% increased hospice enrollment rate (p = 0.0005) and a 240% increased median hospice length of stay compared to usual care (34 days vs. 10 days; p < 0.0001).Conclusion: HBPC within an ACO was associated with significant cost savings, fewer hospitalizations, and increased hospice use in the final months of life.
  • 16.

    【2hr】International Association for Hospice and Palliative Care Position Statement: Euthanasia and Physician-Assisted Suicide

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    机译 国际临终关怀和姑息治疗协会立场声明：安乐死和医师协助的自杀
    摘要：Background: Reports about regulations and laws on Euthanasia and Physician Assisted Suicide (PAS) are becoming increasingly common in the media. Many groups have expressed opposition to euthanasia and PAS while those in favor argue that severely chronically ill and debilitated patients have a right to control the timing and manner of their death. Others argue that both PAS and euthanasia are ethically legitimate in rare and exceptional cases. Given that these discussions as well as the new and proposed laws and regulations may have a powerful impact on patients, caregivers, and health care providers, the International Association for Hospice and Palliative Care (IAHPC) has prepared this statement.Purpose: To describe the position of the IAHPC regarding Euthanasia and PAS.Method: The IAHPC formed a working group (WG) of seven board members and two staff officers who volunteered to participate in this process. An online search was performed using the terms “position statement”, “euthanasia” “assisted suicide” “PAS” to identify existing position statements from health professional organizations. Only statements from national or pan-national associations were included. Statements from seven general medical and nursing associations and statements from seven palliative care organizations were identified. A working document including a summary of the different position statements was prepared and based on these, an initial draft was prepared. Online discussions among the members of the WG took place for a period of three months. The differences were reconciled by email discussions. The resulting draft was shared with the full board. Additional comments and suggestions were incorporated. This document represents the final version approved by the IAHPC Board of Directors.Result: IAHPC believes that no country or state should consider the legalization of euthanasia or PAS until it ensures universal access to palliative care services and to appropriate medications, including opioids for pain and dyspnea.Conclusion: In countries and states where euthanasia and/or PAS are legal, IAHPC agrees that palliative care units should not be responsible for overseeing or administering these practices. The law or policies should include provisions so that any health professional who objects must be allowed to deny participating.
  • 17.

    【2hr】Accuracy of Oncologists' Life-Expectancy Estimates Recalled by Their Advanced Cancer Patients: Correlates and Outcomes

    包量

    机译 晚期癌症患者召回的肿瘤学家预期寿命估计的准确性：相关性和结果。
    摘要：Background: Oncologists are often reluctant to discuss life-expectancy estimates with their patients because of concerns about their inaccuracy and limited evidence regarding benefits.Objective: Determine oncologist accuracy in predicting their advanced cancer patients' life expectancy and correlates associated with accuracy.Design: Multicenter prospective, longitudinal study of patients with advanced cancer, assessed once at baseline and followed to death. At baseline, patients were asked whether their oncologist had provided them with a life-expectancy estimate.Setting/Subjects: Eighty-five patients with advanced cancer recruited from outpatient cancer clinics.Measurements: Patients' baseline sociodemographic and time to death, and clinical characteristics were examined to determine their associations with the accuracy of the oncologists' life-expectancy estimates as recalled by their patients.Results: Seventy-four percent (63/85) of patients recalled that physician life-expectancy estimates were accurate to within a year; estimates were most accurate when patients had 9–12 months to live. Factors significantly (p < 0.05) positively associated with oncologists' greater accuracy to within a year were the patient's age, recruitment from a community-based oncology clinic, poor performance status, and quality-of-life at baseline. Oncologists' prognoses that were accurate to within a year were associated with greater likelihood of patients, at baseline, acknowledging that they were terminally ill (OR = 12.20, 95% CI = 2.24–66.59), engaging in an end-of-life discussion (OR = 4.22, 95% CI = 1.45–12.29), completing a do-not-resuscitate (DNR) order (OR = 2.94, 95% CI = 1.03–8.41), a lower likelihood of using palliative chemotherapy (OR = 0.30, 95% CI = 0.11–0.85), and clinical trial enrollment (OR = 0.09, 95% CI = 0.02–0.50).Conclusions: Oncologists are able to estimate their patients' life expectancy to within a year. Accuracy to within a year is associated with higher rates of DNR order completion, advance care planning, and lower likelihood of chemotherapy use near death.
  • 18.

    【2hr】Development of the Quality Data Collection Tool for Prospective Quality Assessment and Reporting in Palliative Care

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    机译 开发用于姑息治疗的预期质量评估和报告的质量数据收集工具
    摘要：Background: Assessing and reporting the quality of care provided are increasingly important in palliative care, but we currently lack practical, efficient approaches for collection and reporting.Objective: In response, the Global Palliative Care Quality Alliance (“Alliance”) sought to create a Quality Data Collection Tool for Palliative Care (QDACT-PC).Methods: We collaboratively and iteratively developed QDACT-PC, an electronic, point-of-care quality monitoring system for palliative care that supports prospective quality assessment and reporting in any clinical setting. QDACT-PC is the web-based data collection and reporting interface. Quality measures selected to be used in QDACT-PC were derived from a systematic review summarizing all published palliative care quality measure sets; Alliance clinical providers prioritized measures to be included in QDACT-PC to ensure maximal clinical relevance. Data elements and variables required to ascertain conformance to all selected quality measures were included in the QDACT-PC data dictionary. Whenever possible, variables collected in QDACT-PC align with validated surveys and/or nationally recognized common data elements. QDACT–PC data elements and software programmed business rules inform real-time assessments of conformance to selected quality measures. Data are deposited into a centralized registry for future analyses.Results: QDACT-PC can be used to report on >80% of all published palliative care quality measures and 100% of high-priority measure.Conclusion: Electronic methods for collecting point-of-care quality monitoring data can be developed using collaborative partnerships between community and academic palliative care providers. Feasibility testing and creation of feedback reports are ongoing.
  • 19.

    【2hr】Patterns of Cost for Patients Dying in the Intensive Care Unit and Implications for Cost Savings of Palliative Care Interventions

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    机译 重症监护病房死亡患者的费用模式及其对姑息治疗干预措施节省成本的影响
    摘要：Background: Terminal intensive care unit (ICU) stays represent an important target to increase value of care.Objective: To characterize patterns of daily costs of ICU care at the end of life and, based on these patterns, examine the role for palliative care interventions in enhancing value.Design: Secondary analysis of an intervention study to improve quality of care for critically ill patients.Setting/Patients: 572 patients who died in the ICU between 2003 and 2005 at a Level-1 trauma center.Methods: Data were linked with hospital financial records. Costs were categorized into direct fixed, direct variable, and indirect costs. Patterns of daily costs were explored using generalized estimating equations stratified by length of stay, cause of death, ICU type, and insurance status. Estimates from the literature of effects of palliative care interventions on ICU utilization were used to simulate potential cost savings under different time horizons and reimbursement models.Main Results: Mean cost for a terminal ICU stay was 39.3K ± 45.1K. Direct fixed costs represented 45% of total hospital costs, direct variable costs 20%, and indirect costs 34%. Day of admission was most expensive (mean 9.6K ± 7.6K); average cost for subsequent days was 4.8K ± 3.4K and stable over time and patient characteristics.Conclusions: Terminal ICU stays display consistent cost patterns across patient characteristics. Savings can be realized with interventions that align care with patient preferences, helping to prevent unwanted ICU utilization at end of life. Cost modeling suggests that implications vary depending on time horizon and reimbursement models.
  • 20.

    【2hr】Care in the Final Month of Life among Adolescent and Young Adult Cancer Patients in Kaiser Permanente Southern California

    包量

    机译 南加州凯撒永久居民青少年和年轻成人癌症患者生命最后一个月的护理
    摘要：Background: Little is known about the care that adolescent and young adult (AYA) patients with cancer receive at the end of life (EOL).Objective: To examine care in the last month of life among AYA patients with cancer.Design: Medical record review of the last 30 days of life.Setting/Subjects: One hundred eleven AYA patients aged 15–39 years at death with either stage I-III cancer and evidence of cancer recurrence or stage IV cancer at diagnosis. Patients received care in Kaiser Permanente Southern California, an integrated healthcare delivery system, and died from 2007 to 2010.Measurements: Use of intensive measures, including chemotherapy in the last 14 days of life and emergency room visits, hospitalizations, and intensive care unit admissions in the last 30 days; documented care preferences; symptom prevalence and treatment; advance care planning; hospice use; and location of death.Results: One hundred seven patients (96%) had documented care preferences in the last month of life. At first documentation, 72% of patients wished for life-prolonging care, 20% wished for care focused on comfort, and 8% were undecided. Forty-seven percent of patients had documented changes in preferences in the last month, with 40% wishing for life-prolonging care when preferences were last noted before death, 56% preferring comfort, and 4% undecided. Seventy-eight percent of patients received at least one form of intensive EOL care, including 75% of those who preferred comfort measures at last documentation.Conclusions: Many AYA patients enter the last month of life wishing for life-prolonging care. While most ultimately wish for comfort, intensive care is prevalent even among such patients.
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