Interprofessional Rounds Improve Timing of Appropriate Palliative Care Consultation on a Hospitalist Service

Khateeb, Rafina; Puelle, Margaret R.; Firn, Janice; Saul, D'Anna; Chang, Robert S.; Min, Lillian

doi:10.1177/1062860618768069

Cited by 11 publications

(18 citation statements)

References 24 publications

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“…Here, improvements have been shown when specialist PC was integrated into existing practice through interdisciplinary teamwork, 24 , 26 palliative consultations 4 , 24 and palliative rounds. 27 Since palliative medicine recently has become a formal speciality in Sweden, a model for cooperation between specialized palliative medicine and other specialties is of importance as has been emphasized in other countries in the corresponding situation. 28 Educational activities including not only health care students and professionals but also patients, families and the public are necessary.…”

Section: Discussionmentioning

confidence: 99%

Quality of care for the dying across different levels of palliative care development: A population-based cohort study

et al. 2018

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Background:There is a lack of knowledge about how the provision and availability of specialized palliative care relates to the quality of dying in hospital and community-based settings.Aim:We aimed to explore the quality of care during last week of life in relation to different levels of palliative care development.Design:We investigated access to palliative care in Southern Sweden, where one region offers palliative care in accordance with European Association for Palliative Care guidelines for capacity, and the other region offers less developed palliative care. Data on approximately 12,000 deaths during 2015 were collected from the Swedish Register of Palliative Care. The quality of care was investigated by region, and was measured in terms of assessment of oral health and of pain, and end-of-life conversation, companionship at death and artificial nutrition/fluid in the last 24 h.Results:The overall quality of care during last week of life was not consistently better in the region with fully developed palliative care compared with the less developed region. In fact, for patients dying in hospitals and community-based settings, the quality was statistically significantly better in the less developed region. The small proportion of patients who had access to specialized palliative care had superior quality of care during the last week of life as compared to patients in other care settings.Conclusion:The capacity of specialized palliative care does not per se influence the quality of care during the last week of life for patients in other settings.

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Section: Discussionmentioning

confidence: 99%

Quality of care for the dying across different levels of palliative care development: A population-based cohort study

et al. 2018

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“…Most interestingly, we found that whether a patient was cared for by a medical service or a surgical service affected their receipt of PCC with regard to the primary language they spoke: The finding of low utilization of PCC has been consistently reported in the literature. 3,18,23,24 However, it remains unclear whether there is a disproportionate underutilization of PCC in racial and ethnic minorities. Our findings of there being no association between a patient's race/ethnicity and their receipt of PCC at our hospital is consistent with those reported for patients with devastating neurovascular events 11,25 and terminal cancer, 9,10 but in sharp contrast to those reported for patients with renal disease 4 and COPD.…”

Section: Discussionmentioning

confidence: 99%

“…2 However, there is still underutilization of these services in the inpatient setting. 3 A review of patient-level factors associated with low utilization of PCC in the inpatient setting suggests that race and ethnicity are possible contributors, while variables such as education level, English language proficiency, insurance status, and income remain understudied.…”

Section: Introductionmentioning

confidence: 99%

Patient-Level Factors Influencing Palliative Care Consultation at a Safety-Net Urban Hospital

Nguyen

Feeney

Kim³

et al. 2020

Am J Hosp Palliat Care

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The influence of patient-level factors on palliative and hospice care is unclear. We conducted a retrospective review of 2321 patients aged ≥18 that died within 6 months of admission to our institution between 2012 and 2017. Patients were included for analysis if their chart was complete, their length of stay was ≥48 hours, and if based on their diagnoses, they would have benefited from palliative care consultation (PCC). Bayesian regression with a weakly informative prior was used to find the odds ratio (OR) and 99% credible interval (CrI) of receiving PCC based on race/ethnicity, education, language, insurance status, and income. 730 patients fit our inclusion criteria and 30% (n = 211) received PCC. The OR of receiving PCC was 1.26 (99% CrI, 0.73-2.12) for Blacks, 0.81 (99% CrI, 0.31-1.86) for Hispanics, and 0.69 (99% CrI, 0.19-2.46) for other minorities. Less than high school education was associated with greater odds of PCC (OR 2.28, 99% CrI, 1.09-4.93) compared to no schooling. Compared to English speakers, non-English speakers had higher odds of receiving PCC when cared for by medical services (OR 3.01 [99% CrI, 1.44-5.32]) but lower odds of PCC when cared for by surgical services (0.22 [99% CrI, <0.01-3.42]). Insurance status and income were not associated with differences in PCC. At our institution, we found no evidence of racial/ethnic, insurance, or income status affecting PCC while primary language spoken and educational status did. Further investigation is warranted to examine the system and provider-level factors influencing PCC’s low utilization by medical and surgical specialties.

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“…9 There is a growing need for hospital medicine physicians to access palliative care for their patients. [10][11][12] However, hospital-based palliative care resources are too limited to ensure that these patients receive palliative care. 13 Therefore, to meet the palliative care needs of these seriously ill patients at Mount Sinai Hospital, a 1144-bed quaternary-care teaching facility located in New York City, we initiated an innovative social worker-led primary palliative care model embedded within the hospital medicine service (Fig.…”

Section: Introductionmentioning

confidence: 99%

A Social Worker-Led Primary Palliative Care Model for Hospitalized Patients Admitted to the Hospital Medicine Service

Berglund

Chai

Moreno

et al. 2020

Palliative Medicine Reports

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Objective: To increase earlier access to palliative care, and in turn increase documented goals of care and appropriate hospice referrals for seriously ill patients admitted to hospital medicine. Background: Due to the growing number of patients with serious illness and the specialty palliative care workforce shortage, innovative primary palliative care models are essential to meet this population's needs. Methods: Patients with serious illness admitted to hospital medicine at a quaternary urban academic medical center in New York City and received an embedded palliative care social worker consultation in 2017. We used univariate analyses of sociodemographic, clinical, and utilization data to describe the sample. Results: Overall, 232 patients received a primary palliative care consultation (mean age of 69 years, 44.8% female, 34% white, median Karnofsky Performance Status of 40%), and 159 (69%) had capacity to participate in a goals-of -are conversation. Referrals were from palliative care solid tumor oncology trigger program (113 [49%]), specialty palliative care consultation team (42[18%]), and hospital medicine (34[14.6%]). Before the consultation, 10(4.3%) had documented goals of care and 207 (89%) did after the consultation. The percentage of those referred to hospice was 24.1%. Of those transferred to specialty palliative care consultation service, nearly half required symptom management. Discussion: Patients who received a primary palliative care consultation were seen earlier in their illness trajectory, based on their higher functional impairment, and the majority had capacity to participate in goals-of-care discussions, compared with those who were seen by specialty palliative care. The consultation increased goals-of-care documentation and the hospice referral rate was comparable with that of the specialty palliative consultation team.

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Interprofessional Rounds Improve Timing of Appropriate Palliative Care Consultation on a Hospitalist Service

Cited by 11 publications

References 24 publications

Quality of care for the dying across different levels of palliative care development: A population-based cohort study

Quality of care for the dying across different levels of palliative care development: A population-based cohort study

Patient-Level Factors Influencing Palliative Care Consultation at a Safety-Net Urban Hospital

A Social Worker-Led Primary Palliative Care Model for Hospitalized Patients Admitted to the Hospital Medicine Service

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