Epidemiology And Patterns Of Care At The End Of Life: Rising Complexity, Shifts In Care Patterns And Sites Of Death

Aldridge, Melissa D.; Bradley, Elizabeth H.

doi:10.1377/hlthaff.2017.0182

Cited by 102 publications

(106 citation statements)

References 47 publications

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“…First, these data were collected from 2008 through 2010 and thus may not reflect the current hospice market. However, as our results are in line with other recent studies, 2,3 we have no reason to believe that the patterns of hospice use have changed. Second, neither the National Hospice Survey data nor the Medicare hospice claims data include information regarding the reasons for patient disenrollment from hospice or how disenrollment from hospice is related to patient and family preferences for care.…”

Section: Discussionsupporting

confidence: 91%

“…1 Between 2000 and 2015, the number of individuals who died from Alzheimer disease increased by 123% (or 61,000 individuals). 2 An increasing number of people with dementia are enrolling with hospice at the end of life and they represent the fastest growing group of hospice users. 3 As codified under Medicare, hospice provides a package of clinical and psychosocial services to Medicare beneficiaries who are considered to have a terminal diagnosis (defined as a life expectancy of ≤6 months) and who are willing to forgo Medicare coverage for curative treatment.…”

mentioning

confidence: 99%

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Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study

Vleminck

Morrison

Meier

et al. 2018

Journal of the American Medical Directors Association

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Background Patients with dementia form an increasing proportion of those entering hospice care. Little is known about the types of hospices serving patients with dementia and the patterns of hospice use, including timing of hospice disenrollment between patients with and without dementia. Objectives To characterize the hospices that serve patients with dementia, to compare patterns of hospice disenrollment for patients with dementia and without dementia, and to evaluate patient-level and hospice-level characteristics associated with hospice disenrollment. Methods We used data from a longitudinal cohort study (2008–2011) of Medicare beneficiaries (n = 149,814) newly enrolled in a national random sample of hospices (n = 577) from the National Hospice Survey and followed until death (84% response rate). Results A total of 7328 patients (4.9%) had a primary diagnosis of dementia. Hospices caring for patients with dementia were more likely to be for-profit, larger sized, provide care for more than 5 years, and serve a large (>30%) percentage of nursing home patients. Patients with dementia were less likely to disenroll from hospice in conjunction with an acute hospitalization or emergency department visit and more likely to disenroll from hospice after long enrollment periods (more than 165 days) as compared with patients without dementia. No significant difference was found between patients with and without dementia for disenrollment after shorter enrollment periods (less than 165 days). In the multivariable analyses, patients were more likely to be disenrolled after 165 days if they were served by smaller hospices and hospices that served a small percentage of nursing home patients. Conclusion Patients with dementia are significantly more likely to be disenrolled from hospice following a long enrollment period compared with patients without dementia. As the number of individuals with dementia choosing hospice care continues to grow, it is critical to address potential barriers to the provision of quality palliative care for this population near the end of life.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study

Vleminck

Morrison

Meier

et al. 2018

Journal of the American Medical Directors Association

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“…As such, it offers a repository with sufficient size and scope to support analyses of detailed clinical care and assessments of important subgroups of patients, such as those with serious illness, including ''high-cost, high-need'' patients who particularly benefit from palliative care. 13,[21][22][23] In addition, EHR data are recorded directly from documentation of healthcare delivery and utilization without requiring additional data entry beyond that accompanying routine care. The EHR also captures social determinants of health, which are important to the delivery of high-quality, accountable care for the seriously ill. 24 Alongside these strengths, the EHR has important limitations.…”

Section: Strengths and Weaknesses Of The Ehr For Palliative Care Qualmentioning

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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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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“…3 Despite highly concentrated spending, care of this patient population is frequently of low quality: poorly coordinated with multiple transitions across sites of care; marked by inadequate symptom control and low patient and family perceptions of the quality of care; and potentially discordant with personal goals and preferences. [5][6][7][8][9][10][11][12] Healthcare reform aims to improve the value (i.e., raise quality while holding stable or lowering costs) of care for these highest-cost seriously ill patients. 13 In select groups, palliative care interventions (including an interdisciplinary team of physicians, nurses, social workers, and chaplains) have been shown to improve quality of life, manage symptoms, and support patients and families, and lower costs.…”

Section: Introductionmentioning

confidence: 99%

Identifying the Population with Serious Illness: The “Denominator” Challenge

KelleyAmy

Bollens-LundEvan

2018

Journal of Palliative Medicine

159

118

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Background: To ensure seriously ill people and their families receive high-quality primary and specialty palliative care services, rigorous methods are needed to prospectively identify this population. Objective: To define and operationalize a definition of serious illness for the purpose of identifying patients and caregivers who need primary or specialty palliative care services. Design/Setting: Two stages of work included (1) building expert consensus around a conceptual definition of serious illness and (2) using the National Health and Aging Trends Study linked to Medicare claims data to test a range of operational definitions composed of diagnoses, utilization, and markers of care needs. Measurements: One-year outcomes included mean total Medicare costs, mortality, and percent hospitalized, as well as those reporting ‡2 measures of need and functional impairment. Sensitivity, specificity, and c-statistics (unadjusted and adjusted for age, sex, race, and Medicaid status) were calculated for each definition across the outcomes. Results: Conceptually, ''Serious illness'' is a health condition that carries a high risk of mortality AND either negatively impacts a person's daily function or quality of life, OR excessively strains their caregivers. The range of operational definitions simulated all had low sensitivity and high specificity across all outcomes. None of the definitions reached an unadjusted c-statistic >0.6 (or adjusted >0.7) for identifying a population with ‡2 indicators of care needs. Conclusions: Standard administrative data are inadequate to identify this population. Defining the seriously ill denominator with high specificity, as described here, will focus efforts toward the highest-need segment of the population, who may indeed benefit most.

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Epidemiology And Patterns Of Care At The End Of Life: Rising Complexity, Shifts In Care Patterns And Sites Of Death

Cited by 102 publications

References 47 publications

Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study

Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study

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

Identifying the Population with Serious Illness: The “Denominator” Challenge

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