Association between Early Palliative Care Referrals, Inpatient Hospice Utilization, and Aggressiveness of Care at the End of Life

Amano, Koji; Morita, Tatsuya; Tatara, Ryohei; Katayama, Hirofumi; Uno, Teruaki; Takagi, Ibuki

doi:10.1089/jpm.2014.0132

Cited by 77 publications

(63 citation statements)

References 32 publications

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“…The hospice enrollment finding was consistent with Wang and colleagues (31), who found in a study of adult Medicaid patients with cancer, that palliative care had no significant effect on hospice enrollment. The findings from this study are, however, inconsistent with several studies that showed palliative care positively influences adult hospice enrollment (27-29). It is possible that children and families in this study may have remained in palliative care until the death of the child.…”

Section: Discussioncontrasting

confidence: 99%

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The Effect of Pediatric Palliative Care Policy on Hospice Utilization Among California Medicaid Beneficiaries

Lindley

2016

Journal of Pain and Symptom Management

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Background California implemented pediatric palliative care legislations that allowed children to receive curative and supportive care from diagnosis of a life-threatening, serious illness in 2010. Palliative care policies may improve access to hospice care as children near end of life. Objectives To examine the effect of the palliative care policy on hospice utilization for children and their families was investigated. Research Design Using 2007 and 2010 California Medicaid data, a difference-in-difference analysis was conducted to analyze hospice use (i.e., hospice enrollment, hospice length of stay) changes for children who resided in pediatric policy counties relative to those who did not. Population Studied The sample of children in California who died with a life-threatening, serious illness in 2007 and 2010 equaled 979 children. Results Over 10% of children enrolled in hospice care with an average of less than 3 days of hospice care. The palliative care policy did not have any effect on hospice enrollment. However, the policy was positively associated with increasing days in hospice care (IRR= 5.61, p<0.05). The rate of hospice length of stay increased by a factor of 5.61 for children in palliative care counties, compared to children unaffected by the policy. Conclusions The pediatric palliative care policy was associated with longer lengths of stay in hospice once the children were enrolled. Policies promoting palliative care are critical to ensuring access to hospice care for children.

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Section: Discussioncontrasting

confidence: 99%

“…Recent adult studies have shown that patients receiving palliative care often have enhanced hospice enrollment and longer lengths of stay in hospice (27-31). Children receiving palliative care may transition to hospice care as end of life nears, where they would receive intensive pain and symptom management along with bereavement services.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Pediatric Palliative Care Policy on Hospice Utilization Among California Medicaid Beneficiaries

Lindley

2016

Journal of Pain and Symptom Management

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“…The evidence indicates that timely referral into palliative care services has a positive impact on quality of life and can reduce hospitalisation and symptom burden [46] but research in this area is largely North American [47,48] or Japanese [49] and mainly relates to patients with cancer. Exceptions to this include investigative studies into symptom focused interventions for conditions such as breathlessness [50,51].…”

Section: Discussionmentioning

confidence: 99%

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

et al. 2018

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Background: The Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these 'Innovation Centres'. The evaluation aimed to assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites. Methods: The study was set within a Realist Evaluation framework and used a longitudinal, mixed methods research design. Data collection over 15 months (2014)(2015)(2016) Qualitative data methods included: focus groups with project team and staff (n = 32 groups with n = 190 participants), and, volunteers (n = 6 groups with n = 32 participants). Quantitative data were analysed using SPPS Vs. 21 and qualitative data was examined via thematic analysis. Results: Comparison of findings across the six sites revealed the impact of their unique configurations on outcomes, compounded by variations in stage and mode of implementation. PPS, PPI and IPOS data revealed disparity in early referral criteria, complicated by contrasting interpretations of palliative care. The qualitative analysis, CSNAT and VOICES-SF data confirmed the value of the Macmillan model of care but uptake of specialist home-based clinical interventions was limited. The Macmillan brand engendered patient and carer confidence, bringing added value to existing services. Significant findings included better co-ordination of palliative care through project management and a single referral point and multi-disciplinary teamwork including leadership from consultants in palliative medicine, the role of health care assistants in rapid referral, and volunteer support. Conclusions: Macmillan Specialist Care at Home increases patient choice about place of death and enhances the quality of end of life experience. Clarification of key components is advocated to aid consistency of implementation across different sites and support future evaluative work.

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“…Both models have demonstrated favorable outcomes including less aggressive care at the end of life, increased hospice referrals, and improved depression and quality of life and greater family satisfaction [52,53,[57][58][59][60]. As one would predict, better outcomes in one area tend to lead to better outcomes in other areas [39].…”

Section: Early Palliative Care In Cancer Carementioning

confidence: 99%

Promoting further use of palliative care in cancer care centers

Davis

Carrino

2016

Expert Review of Quality of Life in Cancer Care

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Palliative care has changed since its inception with Dr Balfour Mount in 1976. It is moving slowly from the care of the dying (which is still an important part of palliative care) and crisis intervention to integrated care with oncology early in the course of advanced cancer. Several studies have demonstrated the advantages to this approach. In this review we will discuss indicators of structure process and outcomes, outcomes to integration, components to successful integration of care and barriers to integrated care. Family financial toxicity related to cancer care is a growing problem that will need to be measured as an outcome to integrated care ARTICLE HISTORY

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Association between Early Palliative Care Referrals, Inpatient Hospice Utilization, and Aggressiveness of Care at the End of Life

Abstract: Early palliative referrals were associated with more inpatient hospice utilization and less aggressive EOL care.

Cited by 77 publications

References 32 publications

The Effect of Pediatric Palliative Care Policy on Hospice Utilization Among California Medicaid Beneficiaries

The Effect of Pediatric Palliative Care Policy on Hospice Utilization Among California Medicaid Beneficiaries

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

Promoting further use of palliative care in cancer care centers

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