Impact of a Hospice Emergency Kit for Veterans and Their Caregivers: A Prospective Cohort Study

Bailey, F. Amos; Williams, Beverly Rosa; Goode, Patricia S.; Woodby, Lesa L.; Granstaff, U. Shanette; Echt, Katharina V.; Redden, David T.; Kvale, Elizabeth; Burgio, Kathryn L.

doi:10.1089/jpm.2013.0395

Cited by 10 publications

(5 citation statements)

References 16 publications

(24 reference statements)

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“…21,35 Increased caregiver confidence associated with Symptom Response Kits may explain the added effect of these kits on place of death in this study. 17,20 In contrast to previous literature, our primary analyses do not support an impact of the Yellow Folder or Symptom Response Kit on acute care utilization. Patients, caregivers, and health care providers have previously reported reduced rates of unscheduled interventions and hospital visits in emergency medication kit recipients, although these studies may be limited by recall bias.…”

Section: Discussioncontrasting

confidence: 99%

“…Patients, caregivers, and health care providers have previously reported reduced rates of unscheduled interventions and hospital visits in emergency medication kit recipients, although these studies may be limited by recall bias. 15,17,18,20,23 Although our sensitivity analyses demonstrated reduced hospital utilization rates among intervention recipients when we focused on the period preceding death, these post hoc analyses should be viewed as hypothesis generating.…”

Section: Discussionmentioning

confidence: 90%

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Community Palliative Care Initiatives to Reduce End-of-Life Hospital Utilization and In-Hospital Deaths: A Population-Based Observational Study Evaluating Two Home Care Interventions

Webber

Viola

Knott

et al. 2019

Journal of Pain and Symptom Management

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Context. The end-of-life period is characterized by increased hospital utilization despite patients' preferences to receive care and die at home. Objectives. To evaluate the impact of interventions aimed at planning for a home death (Yellow Folder) and managing symptoms in the home (Symptom Response Kit) on place of death and hospital utilization among palliative home care patients. Methods. This was an ecologic and retrospective cohort study of palliative home care patients in southeastern Ontario from April 2009 to March 2014. Linked health administrative and clinical databases were used to identify palliative home care patients and their receipt of the interventions, hospitalizations, emergency department visits, and place of death. Bivariable and multivariable regressions were used to evaluate outcomes according to patients' receipt of intervention(s). Results. The proportion of patients who died in the community increased after implementation of the interventions, from 42.8% to 48.5% (P < 0.0001). Compared with patients who received neither intervention, patients who received the Yellow Folder or Symptom Response Kit had an increased likelihood of dying in the community, with the largest relative risk observed in patients who received both interventions (relative risk ¼ 2.20, 95% confidence interval 2.05e2.36). Receipt of these interventions was only associated with reductions in hospitalization or emergency department visit rates in the six months before death. Conclusion. Patients who received the Yellow Folder or Symptom Response Kit were more likely remain at home at the end of life. This association was stronger when these interventions were used together.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 90%

Community Palliative Care Initiatives to Reduce End-of-Life Hospital Utilization and In-Hospital Deaths: A Population-Based Observational Study Evaluating Two Home Care Interventions

Webber

Viola

Knott

et al. 2019

Journal of Pain and Symptom Management

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“…16 To make dying at home more feasible, prevention of short admissions in the final days of life was recommended. 21 Notably, there are services and practical suggestions (such as mobile palliative care teams, hospice emergency kits with instructions in their use for family members 22,23 ) that enable families to care for the dying at home. Moreover, General Practitioners (GPs) play a central role in providing continuity of care and helping to avoid unnecessary hospitalizations at the end of life.…”

Section: Introductionmentioning

confidence: 99%

Reasons for and Frequency of End-of-Life Hospital Admissions: General Practitioners' Perspective on Reducing End-of-Life Hospital Referrals

Giezendanner

Bally

Haller

et al. 2018

Journal of Palliative Medicine

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The results suggest that adequate support of and a care network for palliative patients and their caregivers are crucial for continuous home-based EOLC. Timely recognition of the advanced palliative phase as well as the involvement of well-trained GPs who feel confident in palliative care, together with adequate financial support for outpatient palliative care, might diminish the frequency of transitions shortly before death.

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“…Furthermore, our study revealed that lacking medical equipment, e.g., specific medication for palliative—not emergency—care, also causes challenging situations. In literature, some studies focussing on the use of emergency medicine kits in home hospice patients are indicating that these medications kits could be helpful to provide timely symptom relief and may diminish the need for prehospital emergency care [13, 14]. These findings add some new aspects to improve prehospital emergency care in patients with advanced incurable diseases in their familiar home environment.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, studies showed that some emergency department visits might be avoidable and are related to some such as pain medication refills or constipation [12]. The use of emergency medicine kits in home hospice patients seems to be helpful and might provide a timely symptom relief and may diminish the need for prehospital emergency care [13, 14]. Nevertheless, there are still unavoidable emergency department visits related to infections or neurologic events.…”

Section: Introductionmentioning

confidence: 99%

Challenges Faced by Prehospital Emergency Physicians Providing Emergency Care to Patients with Advanced Incurable Diseases

Kamphausen

Roese

Issleib

et al. 2019

Emergency Medicine International

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Introduction The aim of our study was to investigate challenges faced by emergency physicians (EPs) who provide prehospital emergency care to patients with advanced incurable diseases and family caregivers in their familiar home environment. Methods Qualitative study using semistructured interviews with open-ended questions to collect data from 24 EPs. Data were analyzed using qualitative content analysis. Results We identified nine categories of challenges: structural conditions of prehospital emergency care, medical documentation and orders, finding optimal patient-centered therapy, uncertainty about legal consequences, challenges at the individual (EP) level, challenges at the emergency team level, family caregiver's emotions, coping and understanding of patient's illness, patient's wishes, coping and understanding of patient's illness, and social, cultural, and religious background of patients and families. EPs strengthened that the integrations of specialized prehospital palliative care services improved emergency care by providing resources to patients and family caregivers, enhancing the quality and availability of medical documentation and accessibility of aftercare in emergencies. Areas of improvement that were identified were to promote emergency physicians' knowledge and skills in palliative care, communication, and family caregiver support by education and training. Furthermore, structures for better care on-site, thorough medical documentation, and specialized palliative care emergency facilities in hospital and prehospital care were requested. Conclusion Prehospital emergency care in patients with advanced incurable diseases in their familiar home environment may be improved by training EPs in palliative care, communication, and caregiver support competences. Results underline the importance of collaborative specialized palliative care and prehospital emergency care.

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Impact of a Hospice Emergency Kit for Veterans and Their Caregivers: A Prospective Cohort Study

Abstract: Findings provide promising evidence that HEKs are a feasible and well-tolerated method for achieving timely relief of emergent symptoms in home hospice patients and possibly avoiding unwanted ED visits and hospitalizations.

Cited by 10 publications

References 16 publications

Community Palliative Care Initiatives to Reduce End-of-Life Hospital Utilization and In-Hospital Deaths: A Population-Based Observational Study Evaluating Two Home Care Interventions

Community Palliative Care Initiatives to Reduce End-of-Life Hospital Utilization and In-Hospital Deaths: A Population-Based Observational Study Evaluating Two Home Care Interventions

Reasons for and Frequency of End-of-Life Hospital Admissions: General Practitioners' Perspective on Reducing End-of-Life Hospital Referrals

Challenges Faced by Prehospital Emergency Physicians Providing Emergency Care to Patients with Advanced Incurable Diseases

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