Variability in Access to Hospital Palliative Care in the United States

Goldsmith, Benjamin; Dietrich, Jessica; Du, Qingling; Morrison, R. Sean

doi:10.1089/jpm.2008.0053

Cited by 171 publications

(132 citation statements)

References 10 publications

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“…12,19,20 Despite the benefits of palliative care [18][19][20][21][22][23][24][25] and its growth in recent years, 20,25,27 it is not always available for inpatients, partly because the subspecialty palliative care workforce is not currently sufficient to reach all patients dying in hospital settings and partly because practitioners do not recognize shifts in patient trajectory indicating the need for palliative care consultation. [26][27][28][29][30][31][32] In an environment focusing on "cure," transition away from disease-modifying treatments to symptom control can seem counterintuitive. Because most Americans are likely to die in a hospital or nursing home, 20,33,34 there is a compelling need to address processes of care for actively dying patients in inpatient settings.…”

Section: Introductionmentioning

confidence: 99%

Intervention to Improve Care at Life’s End in Inpatient Settings: The BEACON Trial

et al. 2014

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BACKGROUND: Widespread implementation of palliative care treatment plans could reduce suffering in the last days of life by adopting best practices of traditionally home-based hospice care in inpatient settings. OBJECTIVE: To evaluate the effectiveness of a multimodal intervention strategy to improve processes of end-of-life care in inpatient settings. DESIGN: Implementation trial with an intervention staggered across hospitals using a multiple-baseline, stepped wedge design. PARTICIPANTS: Six Veterans Affairs Medical Centers (VAMCs). INTERVENTION: Staff training was targeted to all hospital providers and focused on identifying actively dying patients and implementing best practices from home-based hospice care, supported with an electronic order set and paper-based educational tools. MAIN MEASURES: Several processes of care were identified as quality endpoints for end-of-life care (last 7 days) and abstracted from electronic medical records of veterans who died before or after intervention (n= 6,066). Primary endpoints were proportion with an order for opioid pain medication at time of death, donot-resuscitate order, location of death, nasogastric tube, intravenous line infusing, and physical restraints. Secondary endpoints were administration of opioids, order/administration of antipsychotics, benzodiazepines, and scopolamine (for death rattle); sublingual administration; advance directives; palliative care consultations; and pastoral care services. Generalized estimating equations were conducted adjusting for longitudinal trends. KEY RESULTS: Significant intervention effects were observed for orders for opioid pain medication (OR:

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Section: Introductionmentioning

confidence: 99%

Intervention to Improve Care at Life’s End in Inpatient Settings: The BEACON Trial

et al. 2014

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“…[1][2][3][4][5] Evidence-based research is required, systematically appraising the outcomes of programs and identifying the key processes and structures underpinning these outcomes. [6][7][8] Payers and policymakers require evidence to validate current palliative care provision, to explore ways that this could be made more cost effective, and to assess the case for new programs.…”

mentioning

confidence: 99%

Economic Impact of Hospital Inpatient Palliative Care Consultation: Review of Current Evidence and Directions for Future Research

May

Normand

Morrison

2014

Journal of Palliative Medicine

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136

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Background: Maintaining the recent expansion of palliative care access in the United States is a recognized public health concern. Economic evaluation is essential to validate current provision and assess the case for new programs. Previous economic reviews in palliative care reported on programs across settings and systems; none has examined specifically the hospital consultative model, the dominant model of provision in the United States. Objectives: To review systematically the economic evidence on specialist palliative care consultation teams in the hospital setting, to appraise this evidence critically, and to identify areas for future research in this field. Data Sources: A meta-review (''a review of existing reviews'') was conducted of eight published systematic reviews and one relevant nonsystematic review. To identify articles published outside of the timeframe of these reviews, systematic searches were performed on the PubMed, CINAHL, and EconLit databases. Study Selection: Articles were included if they compared the costs and/or cost effectiveness of a specialist hospital inpatient palliative care consultation for adult patients with those of a comparator. Results: Ten studies were included and these demonstrate a clear pattern of cost-saving impact from inpatient consultation programs. Nevertheless, knowledge gaps still exist regarding the economic effects of these programs. Current evidence has been generated from the hospital perspective; health system costs, patient and caregiver costs, and health outcomes are typically not included. Conclusions: Inpatient palliative care consultation programs have been shown to save hospitals money and to provide improved care to patients with serious illness. With a clear pattern of cost-saving using current methodology, it is timely to begin expanding the scope of economic evaluation in this field. Future research must address the measurement of both costs and outcomes to understand more fully the role that palliative care plays in enhancing value in health care. Relevant domains for such research are identified.

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“…In 2008 that number was just under 1,500 and in 2010 we're up above 1,500 now. That's 55% of all hospitals in the United States but more importantly it's 75% of our major hospitals, those with more than 300 beds (Goldsmith et al 2008;AHA 2009) As more patients are being taken care of in nonhospice palliative care, we're seeing those patients enter into hospice as well because it is a natural transition for them. In 2008, 40% of people accessed their hospice benefit before they died (NHPCO 2009 We've seen a dramatic increase in the number of clinical palliative care programs.…”

Section: Palliative Care In 2010mentioning

confidence: 99%

“…My colleagues and I analyzed administrative data from eight very diverse hospitals serving both low-, medium-, and high-income markets in a mixture of community hospitals, academic medical centers, and cancer centers (Morrison et al 2008). On average, people who received palliative care and were subsequently discharged saved about $174 per day, or $1,700 per admission.…”

Section: Palliative Care Addresses Patients' and Families' Needsmentioning

confidence: 99%