Community‐based serious illness care for patients with dementia

Noah, Hannah; Daaleman, Timothy P.; Kistler, Christine E.

doi:10.1016/j.trci.2018.06.011

Cited by 3 publications

(5 citation statements)

References 9 publications

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“…The REACH program was a community-based seriousillness care program that extended both medical and palliative care to seriously ill and medically complex adults in their homes or assisted living communities [16][17][18]. The REACH program was designed to meet the needs of patients and primary care providers and thus offered an array of services from short-term consultation to ongoing co-management to assuming primary care if needed.…”

Section: Community-based Serious-illness Care Modelmentioning

confidence: 99%

“…To better understand the current quality-of-care, we created operational definitions for selected quality-of-care measures and used them to evaluate a community-based serious-illness care program. The program has been evaluated for its impact in older adults with dementia, its impact on healthcare utilization, and in palliative care, but not in proposed quality-of-care [ 16 , 17 ]. The aim of the study was to determine if we could operationalize proposed quality-of-care domains and then evaluate our program [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the care provision of a community-based serious-illness care program via chart measures

et al. 2020

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Background Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model. Methods Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n = 159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access. Results Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35, 22, 21%, respectively). Conclusion This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.

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Section: Community-based Serious-illness Care Modelmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluating the care provision of a community-based serious-illness care program via chart measures

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…The REACH program was a community-based serious-illness care program that extends both medical and palliative care to seriously ill and medically complex adults in their homes or assisted living communities. (16)(17)(18) The REACH program was designed to meet the needs of patients and primary care providers and thus offered an array of services from short-term consultation to ongoing co-management to assuming primary care if needed. The REACH program was interdisciplinary, with a team comprised of: (1) clinicians (MD, DO, nurse practitioner) with expertise in geriatrics and/or palliative care; (2) a clinical pharmacist (PharmD); (3) a care manager (Master's of Social Work); and (4) a nurse coordinator (RN) who trained in the Guided Care model, a model designed to coordinate care across healthcare settings.…”

Section: Community-based Serious-illness Care Modelmentioning

confidence: 99%

“…The program has been evaluated for its impact in older adults with dementia, its impact on healthcare utilization, and in palliative care, but not in proposed quality-of-care. (16,17) The aim of the study was to determine if we could operationalize proposed quality-of-care domains and then evaluate our program. (8,9)…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Care Provision of a Community-Based Serious-Illness Care Program Via Chart Measures

Kistler

Dongen

Ernecoff

et al. 2020

Preprint

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Background: Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model.Methods: Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n=159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access.Results: Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35%, 22%, 21%, respectively). Conclusion: This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.

show abstract

Section: Introductionmentioning

confidence: 99%

Evaluating the Care Provision of a Community-Based Serious-Illness Care Program Via Chart Measures

Kistler

Dongen

Ernecoff

et al. 2019

Preprint

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Keywords: home-based primary care, home-based palliative care, community-based care, quality-of-care, serious-illness care Background: Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model. Methods: Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n=159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access. Results: Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35%, 22%, 21%, respectively). Conclusions: This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures. List of Abbreviations: REACH program (Reaching out to Enhance the care of Adults in their Communities and their Homes), electronic health record (EHR), the Charlson Comorbidity Index (CCI), instrumental activities of daily living (IADLs), activities of daily living (ADLs), Veterans Affairs St. Louis University Mental Status Exam (VA-SLUMS)

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Community‐based serious illness care for patients with dementia

Cited by 3 publications

References 9 publications

Evaluating the care provision of a community-based serious-illness care program via chart measures

Evaluating the care provision of a community-based serious-illness care program via chart measures

Evaluating the Care Provision of a Community-Based Serious-Illness Care Program Via Chart Measures

Evaluating the Care Provision of a Community-Based Serious-Illness Care Program Via Chart Measures

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