Where Americans Die — Is There Really “No Place Like Home”?

Wachterman, Melissa; Luth, Elizabeth A; Semco, Robert; Weissman, Joel S.

doi:10.1056/nejmp2112297

Cited by 18 publications

(11 citation statements)

References 4 publications

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“…Health care systems that adopt and scale such collaborative models through regional organization may improve care alignment and delivery of goal-and need-concordant care. 2 The increased need for palliative care is linked to an aging population with rising morbidity and disability, 37 and a shortage of palliative specialists to meet growing demands. 3,14 Increasing health care capacity through collaborative palliative care models may benefit health care providers, patients and caregivers by enhancing knowledge in caring for complex chronic illness near the end of life.…”

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Regional collaborative home-based palliative care and health care outcomes among adults with heart failure

Quinn

Stukel

Campos

et al. 2022

CMAJ

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Innovative models of collaborative, interdisciplinary palliative care that use shared decision-making to promote goal-and need-concordant care are urgently needed to meet rising demand among people with heart failure. 1,2 Between 2010 and 2015, 75% of people with heart failure in Ontario died in hospital, despite 70% of people preferring an out-of-hospital death and 90% preferring end-of-life health care delivery at home. [3][4][5] Most people also prioritize improvements in quality of life at the end of life over extension of life. 6 Admission to hospital near the end of life is often perceived as undesirable and may result in the provision of unwanted care, whereas home visits near the end of life tend to focus on comfort and are associated with higher rates of death at home. 4,5,7,8 These preferences are recognized at a system level, such that avoidance of unwanted health care and at-home death are considered quality indicators for end-of-life care. 9-11 However, delivering high-quality care for people with heart failure who are near the end of their life is challenging because of their unpredictable illness course and limited capacity of specialist palliative care. 4,[12][13][14] Many studies, including a recent meta-analysis, have shown that home-based palliative care is associated with improved quality of life and symptoms, reduced health care use and a higher likelihood of a home death among people with heart failure. 4,8,12,13,15,16 However, only 32% of people with heart failure received home-based palliative care near the end of life in Ontario. 4,8 Several randomized controlled trials explored the effects of collaborative care models for people with heart failure; [12][13][14][15][16] the results were mixed regarding quality of life, symptoms

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Section: Discussionmentioning

confidence: 99%

“…

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mentioning

confidence: 99%

Regional collaborative home-based palliative care and health care outcomes among adults with heart failure

Quinn

Stukel

Campos

et al. 2022

CMAJ

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“…Prior qualitative research found that hospice staff perceive people with dementia and their surrogate decision‐makers to be unprepared for end‐of‐life care decisions at hospice admission 24 . For people with coexisting or principal dementia, their daily needs far surpass what the Medicare Hospice Benefit supports or organizations may be equipped for, leaving gaps to be filled by family, friends, or paid caregivers 3,25,26 . Though hospice clinicians develop care plans specific to the circumstances and preferences of each enrollee and family, resources (such help from home health aides) must be carefully stewarded within the payment model of the Medicare Hospice Benefit.…”

Section: Discussionmentioning

confidence: 99%

Functional and clinical needs of older hospice enrollees with coexisting dementia

Harrison

Cenzer

Smith

et al. 2022

J American Geriatrics Society

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Background: The Medicare Hospice Benefit increasingly serves people dying with dementia. We sought to understand characteristics, hospice use patterns, and last-month-of-life care quality ratings among hospice enrollees with dementia coexisting with another terminal illness as compared to enrollees with a principal hospice diagnosis of dementia, and enrollees with no dementia.Methods: We conducted a pooled cross-sectional study among decedent Medicare beneficiaries age 70+ using longitudinal data from the National Health and Aging Trends Study (NHATS) (last interview before death; after-death proxy interview) linked to Medicare hospice claims (2011)(2012)(2013)(2014)(2015)(2016)(2017). We used unadjusted and adjusted regression analyses to compare characteristics of hospice enrollees with coexisting dementia to two groups: (1) enrollees with a principal dementia diagnosis, and (2) enrollees with no dementia.Results: Among 1105 decedent hospice enrollees age 70+, 40% had coexisting dementia, 16% had a principal diagnosis of dementia, and 44% had no dementia. In adjusted analyses, enrollees with coexisting dementia had high rates of needing help with 3-6 activities of daily living, similar to enrollees with principal dementia (62% vs. 67%). Enrollees with coexisting dementia had high clinical needs, similar to those with no dementia, for example, 63% versus 61% had bothersome pain. Care quality was worse for enrollees with coexisting dementia versus principal dementia (e.g., 61% vs. 79% had anxiety/sadness managed) and similar to those with no dementia. Enrollees with coexisting dementia had similar hospice use patterns as those with principal diagnoses and higher rates of problematic use patterns compared to those with no dementia (e.g., 16% vs. 10% live disenrollment, p = 0.004).Conclusions: People with coexisting dementia have functional needs comparable to enrollees with principal diagnoses of dementia, and clinical needs comparable to enrollees with no dementia. Changes to hospice care models and policy may be needed to ensure appropriate dementia care.

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“…For example, most older adults express a preference to spend their end‐of‐life time outside the hospital. However, codifying this as a quality measure disincentivizes or even penalizes healthcare systems for deaths that occur in facilities, even if symptoms would be better treated in an inpatient setting 8 …”

Section: What Mattersmentioning

confidence: 99%

What matters when it comes to measuring Age‐Friendly Health System transformation

Burke

Ashcraft

Manges

et al. 2022

J American Geriatrics Society

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Thousands of health systems are now recognized as “Age‐Friendly Health Systems,” making this model one of the most widely disseminated – and most promising‐ models to redesign care delivery for older adults. Sustaining these gains will require demonstrating the impact on care delivery and outcomes of older adults. We propose a new measurement model to more tightly link Age‐Friendly Health System transformation to outcomes within each “M” (What Matters, Medications, Mobility, and Mentation). We evaluated measures based on the following characteristics: (1) conceptual responsiveness to changes brought about by practicing “4Ms” care; (2) degree to which they represent outcomes that matter to older adults; and (3) how they can be feasibly, reliably, and validly measured. We offer specific examples of how novel measures are currently being used where available. Finally, we present measures that could capture system‐level effects across “M”s. We tie these suggestions together into a conceptual measurement model for AFHS transformation, with the intent to spur discussion, debate, and iterative improvement in measures over time.

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Where Americans Die — Is There Really “No Place Like Home”?

Cited by 18 publications

References 4 publications

Regional collaborative home-based palliative care and health care outcomes among adults with heart failure

Regional collaborative home-based palliative care and health care outcomes among adults with heart failure

Functional and clinical needs of older hospice enrollees with coexisting dementia

What matters when it comes to measuring Age‐Friendly Health System transformation

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