Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness

Lavin, Kyle; Davydow, Dimitry S.; Downey, Lois; Engelberg, Ruth A.; Dunlap, Ben; Sibley, James; Lober, William B.; Okimoto, Kelson; Loggers, Elizabeth T.; Teno, Joan M.; Curtis, J. Randall

doi:10.1016/j.jpainsymman.2017.04.003

Cited by 26 publications

(90 citation statements)

References 32 publications

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“…45 We found also that *40% of patients with chronic illness died in a hospital, with almost half of hospital deaths occurring outside the UW Medicine system, highlighting the importance of ensuring that advance care planning is transmitted to other healthcare systems. 46 In addition, we found that the decrease in hospital utilization during the last 30 days of life was consistent for patients older and younger than 65 years, while the decrease in ICU utilization in the last 30 days of life was more prominent for patients older than 65 years.…”

Section: Example Of Specific Metrics Across a Multihospital Healthcarmentioning

confidence: 74%

“…42,50 Examining decedents allows a clear focus on the quality of end-of-life care, but this approach creates a second challenge in that it cannot be used to identify individual patients whose care can be improved, since patients have already died. We are working to define other patient populations with unmet palliative care needs, such as those with psychiatric illness 45 or adult congenital heart disease. 51 A third challenge is that of benchmarking quality and the related consequence of adjudicating accountability for low or high quality.…”

Section: Challenges and Lessons Learned From Ehr-based Metricsmentioning

confidence: 99%

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Using Electronic Health Records for Quality Measurement and Accountability in Care of the Seriously Ill: Opportunities and Challenges

Curtis

Sathitratanacheewin

Starks

et al. 2018

Journal of Palliative Medicine

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Background: As our population ages and the burden of chronic illness rises, there is increasing need to implement quality metrics that measure and benchmark care of the seriously ill, including the delivery of both primary care and specialty palliative care. Such metrics can be used to drive quality improvement, value-based payment, and accountability for population-based outcomes. Methods: In this article, we examine use of the electronic health record (EHR) as a tool to assess quality of serious illness care through narrative review and description of a palliative care quality metrics program in a large healthcare system. Results: In the search for feasible, reliable, and valid palliative care quality metrics, the EHR is an attractive option for collecting quality data on large numbers of seriously ill patients. However, important challenges to using EHR data for quality improvement and accountability exist, including understanding the validity, reliability, and completeness of the data, as well as acknowledging the difference between care documented and care delivered. Challenges also include developing achievable metrics that are clearly linked to patient and family outcomes and addressing data interoperability across sites as well as EHR platforms and vendors. This article summarizes the strengths and weakness of the EHR as a data source for accountability of communityand population-based programs for serious illness, describes the implementation of EHR data in the palliative care quality metrics program at the University of Washington, and, based on that experience, discusses opportunities and challenges. Our palliative care metrics program was designed to serve as a resource for other healthcare systems. Discussion: Although the EHR offers great promise for enhancing quality of care provided for the seriously ill, significant challenges remain to operationalizing this promise on a national scale and using EHR data for population-based quality and accountability.

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Section: Example Of Specific Metrics Across a Multihospital Healthcarmentioning

confidence: 74%

Section: Challenges and Lessons Learned From Ehr-based Metricsmentioning

confidence: 99%

Using Electronic Health Records for Quality Measurement and Accountability in Care of the Seriously Ill: Opportunities and Challenges

Curtis

Sathitratanacheewin

Starks

et al. 2018

Journal of Palliative Medicine

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“…Annual patient volume exceeded 64,000 hospital admissions and 1.6 million outpatient and emergency department visits. 9,10 …”

Section: Methodsmentioning

confidence: 99%

Temporal Trends Between 2010 and 2015 in Intensity of Care at End-of-Life for Patients With Chronic Illness: Influence of Age Under vs. Over 65 Years

Sathitratanacheewin

Engelberg

Downey

et al. 2018

Journal of Pain and Symptom Management

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Context Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65. Objectives To examine recent temporal trends in place of death, and both hospital and ICU utilization, for age-stratified decedents with chronic, life-limiting diagnoses (<65 versus ≥65 years) who received care in a large healthcare system. Methods Retrospective cohort using death certificates and electronic health records for 22,068 patients with chronic illnesses who died between 2010 and 2015. We examined utilization overall and stratified by age using multiple regression. Results The proportion of deaths at home did not change, but hospital admissions in the last 30 days of life decreased significantly from 2010 to 2015 (hospital b=-0.026; CI=-0.041,-0.012). ICU admissions in the last 30 days also declined over time for the full sample and for patients 65 or older (overall b=-0.023, CI=-0.039,-0.007) but was not significant for younger decedents. Length of stay did not decrease for those using the hospital or ICU. Conclusion From 2010 to 2015, we observed a decrease in hospital admissions for all age groups and in ICU admissions for those over 65. As there were no changes in the proportion of patients with chronic illness who died at home nor in hospital or ICU length-of-stay in the last 30 days, hospital and ICU admissions in the last 30 days may be a more responsive quality metric than site of death or length of stay for palliative care interventions.

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“…Characteristics of the 23 included studies are presented in Table 1. Fourteen studies reported health care at end of life (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) and 13 studies reported place of death in patients with a serious mental illness (13,28,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) and. Four studies reported both outcomes (28,(34)(35)(36).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…There was great variability in the size of the study sample from which the sample of people with serious mental illness. In two studies (28,32), the whole sample comprised eligible adult subjects with serious mental illness, whom were included in the synthesis of results, whilst other studies presented results for subsamples with serious mental illness from a Most studies were from the USA (13,24,(30)(31)(32)34,35,38) and Canada (29,36,43); the remaining studies were from Denmark (41,42), the UK (28,44), France (39), the Netherlands (25), Australia (27,33), New Zealand (23), Japan (40) and Taiwan (26,37). The mean/median age of subjects ranged between 47 and 79.…”

Section: Study Characteristicsmentioning

confidence: 99%

End-of-life care and place of death in adults with serious mental illness: A systematic review and narrative synthesis

et al. 2019

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Background: People with serious mental illness have greater mortality risk than the general population. They experience health care inequalities throughout life; it is not clear if this persists to end of life. Aim: Assess the empirical evidence describing end-of-life care and place of death for people with serious mental illness. Design: A systematic review of original, peer-reviewed research, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analysed using a narrative synthesis approach. Data sources: Five online databases (Embase, PsycArticles, PsycINFO, Medline, PubMed) and additional sources were searched (without time restriction) for primary research reporting health care utilisation in the last year of life or place of death in adults with serious mental illness. Results: After full-text screening, 23 studies were included. We found studies reporting hospital admissions, emergency department care, palliative care, and general practitioner (GP) visits at end of life. We found conflicting evidence for the association between serious mental illness and end-of-life care, although different patient groups, settings and measures were used across studies. People with serious mental illness were more likely to die in care homes than the general population. There were no patterns for other places of death. Conclusions: The evidence was sparse and heterogeneous, demonstrating variability in patterns and reporting of health care use and with little consensus on where people with serious mental illness are likely to die. Given that people with serious mental illness have increased mortality risk, this gap in the knowledge around end-of-life care outcomes is concerning; this area of research needs further development.

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Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness

Cited by 26 publications

References 32 publications

Using Electronic Health Records for Quality Measurement and Accountability in Care of the Seriously Ill: Opportunities and Challenges

Using Electronic Health Records for Quality Measurement and Accountability in Care of the Seriously Ill: Opportunities and Challenges

Temporal Trends Between 2010 and 2015 in Intensity of Care at End-of-Life for Patients With Chronic Illness: Influence of Age Under vs. Over 65 Years

End-of-life care and place of death in adults with serious mental illness: A systematic review and narrative synthesis

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