Change in End-of-Life Care for Medicare Beneficiaries

Teno, Joan M.; Gozalo, Pedro; Bynum, Julie; Leland, Natalie E.; Miller, Susan C.; Morden, Nancy E.; Scupp, Thomas; Goodman, David C.; Mor, Vincent

doi:10.1001/jama.2012.207624

Cited by 863 publications

(443 citation statements)

References 22 publications

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“…The importance of such research is evident, as disparities between countries, within countries and among different patient populations do matter on many levels such as quality of care issues [26,27,28,29,30,31], economical aspects [32,33,34] or shifts in the delivery of care over time [35]. …”

Section: Discussionmentioning

confidence: 99%

Cancer-Related Therapies at the End of Life in Hospitalized Cancer Patients from Four Swiss Cantons: SAKK 89/09

Matter-Walstra

Achermann²,

Rapold³

et al. 2014

Oncology

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The use of cancer-related therapies in cancer patients hospitalized at the end of life has increased in many countries over time. Given the scarcity of published Swiss data, the objective of this study was to evaluate the influence of hospital type and other factors on the delivery of health care during the last month before death. Claims data were used to assess health care utilization of cancer patients (identified by cancer registry data of four participating Swiss cantons) who deceased between 2006 and 2008. Primary endpoints were delivery of cancer-related therapies during the last 30 days before death. Multivariate logistic regression assessed the explanatory value of hospital type, patient and geographic characteristics. Of 3,809 identified cancer patients in the claims database, 2,086 patients dying from cancer were hospitalized during the last 30 days before death, generating 2,262 inpatient episodes. Anticancer drug therapy was given in 22.2% and radiotherapy in 11.7% of episodes. Besides age and cancer type, the canton of residence and hospital type showed independent, statistically significant associations with intensity of care, which was highest in university hospitals. These results should initiate a discussion among oncologists in Switzerland and may question the compliance with standard of care guidelines for terminal cancer patients. i 2014 S. Karger AG, Basel

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Section: Discussionmentioning

confidence: 99%

Cancer-Related Therapies at the End of Life in Hospitalized Cancer Patients from Four Swiss Cantons: SAKK 89/09

Matter-Walstra

Achermann²,

Rapold³

et al. 2014

Oncology

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“…Medicare beneficiaries are experiencing record numbers of transitions between health care settings. [2] These data demonstrate that care during transitions could be improved, both in efficacy and efficiency. Care transition models that deliver standardized discharge planning strategies may be efficient; however, these methods do not consider the individual needs of patients (such as patient cognition and activation) and resources or care needed after discharge and thus may be over or under dosed for efficacy with improving patient outcomes for patients with chronic illness.…”

Section: Introductionmentioning

confidence: 84%

Post-hospitalization transition to home: Patient perspectives of a personalized approach

Burbach

Cohen

Zimmerman

et al. 2016

JNEP

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Objective: Successful transition from hospital to home for persons having multiple chronic illnesses is vital for improved health and reduction of hospital readmissions. This qualitative study was undertaken to explore patients' experiences with tailored care transition interventions in order to improve future interventions in a planned larger study. Methods: Eighteen patients were interviewed either individually or in focus groups. Patients had previously completed a larger study that evaluated the impact of post-hospital discharge care transitions interventions, which were tailored to cognitive level and patient activation status. Data were analyzed using qualitative, thematic analysis techniques. Results: The overarching theme identified as a result of the qualitative interviews was: Tailoring Interventions to Address the Complexity of Multiple Chronic Illnesses. It included Checking in or checking out: Patient activation and self-management of chronic illness; Increasing complexity: Management of medications for chronic illness; and Paving a path through complexity with caring. These themes were found in all participants, across all groups of the interventions. Conclusions: Tailored interventions, which included individual assessment of needs and development and implementation of a tailored self-management plan, were viewed as effective by patients for self-management of chronic illness, particularly medication reconciliation and weekly goal setting.

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“…Patient engagement innovations have been stimulated by research demonstrating that many treatment decisions are poorly aligned with patients' goals, values, and preferences for surgical or procedural innovations 214,215 or end-of-life care. 216 As a result, there has been early, but promising, work in the area of incorporating patient education and preferences into shared medical decision making (SDM) in cardiac disease. SDM is a collaborative process that allows patients and their providers to make healthcare decisions together, combining the best scientific evidence available with the individual patient's values and preferences.…”

Section: Patient Engagement With the Lhsmentioning

confidence: 99%

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

Maddox¹,

Albert²,

Borden³

et al. 2017

Circulation

100

118

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ABSTRACT:The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented.H ealth care has never been more complex. Clinicians and patients must make decisions that integrate the continually evolving scientific evidence base with hundreds of individual data points such as patients' vital signs, symptoms, comorbidities, medications, test results, and preferences. Furthermore, once these decisions are made, little information is available about their impact, limiting the ability to learn from and ultimately improve care delivery. This inability of the healthcare system to learn from its operation results in significant inefficiencies, substantial costs, and suboptimal health outcomes.The creation of a learning healthcare system (LHS) can potentially address these issues. The LHS uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery 1,2 (Figure 1). Thus, the LHS enables rapid, iterative learning in which "evidence informs practice, and practice informs evidence." 2 The authors argued that recent advances in information processing and connectivity, healthcare organizational design, and reimbursement policies centered on quality rather than quantity of care provided the necessary tools for the creation of the LHS. Accordingly, they called for systematic redesign of the healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture.

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Change in End-of-Life Care for Medicare Beneficiaries

Cited by 863 publications

References 22 publications

Cancer-Related Therapies at the End of Life in Hospitalized Cancer Patients from Four Swiss Cantons: SAKK 89/09

Cancer-Related Therapies at the End of Life in Hospitalized Cancer Patients from Four Swiss Cantons: SAKK 89/09

Post-hospitalization transition to home: Patient perspectives of a personalized approach

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

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