Defining “Serious Illness”

KelleyAmy, S

doi:10.1089/jpm.2014.0164

Cited by 102 publications

(80 citation statements)

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“…1,25 This article aims to build upon prior work by conceptually defining serious illness and describing the steps needed to operationalize this definition within a healthcare population. [26][27][28][29][30] We align these methods with current alternative payment model (APM) proposals 31,32 and highlight critical challenges and tensions in specifying the approach. To illustrate these issues, we also describe simulated examples of population identification methods using a nationally representative cohort of Medicare beneficiaries.…”

Section: Introductionmentioning

confidence: 99%

Identifying the Population with Serious Illness: The “Denominator” Challenge

KelleyAmy

Bollens-LundEvan

2018

Journal of Palliative Medicine

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167

118

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Background: To ensure seriously ill people and their families receive high-quality primary and specialty palliative care services, rigorous methods are needed to prospectively identify this population. Objective: To define and operationalize a definition of serious illness for the purpose of identifying patients and caregivers who need primary or specialty palliative care services. Design/Setting: Two stages of work included (1) building expert consensus around a conceptual definition of serious illness and (2) using the National Health and Aging Trends Study linked to Medicare claims data to test a range of operational definitions composed of diagnoses, utilization, and markers of care needs. Measurements: One-year outcomes included mean total Medicare costs, mortality, and percent hospitalized, as well as those reporting ‡2 measures of need and functional impairment. Sensitivity, specificity, and c-statistics (unadjusted and adjusted for age, sex, race, and Medicaid status) were calculated for each definition across the outcomes. Results: Conceptually, ''Serious illness'' is a health condition that carries a high risk of mortality AND either negatively impacts a person's daily function or quality of life, OR excessively strains their caregivers. The range of operational definitions simulated all had low sensitivity and high specificity across all outcomes. None of the definitions reached an unadjusted c-statistic >0.6 (or adjusted >0.7) for identifying a population with ‡2 indicators of care needs. Conclusions: Standard administrative data are inadequate to identify this population. Defining the seriously ill denominator with high specificity, as described here, will focus efforts toward the highest-need segment of the population, who may indeed benefit most.

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Section: Introductionmentioning

confidence: 99%

Identifying the Population with Serious Illness: The “Denominator” Challenge

KelleyAmy

Bollens-LundEvan

2018

Journal of Palliative Medicine

Self Cite

167

118

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“…In this article, we describe why the current state, in which most clinicians lack training in communication skills for serious illness, is a barrier to high‐quality medical care for high‐need, high‐risk patients and their families, why communication skills training requires a different approach than other aspects of clinician education, and recent models of training currently addressing these issues. A “serious illness” is a health condition that carries a high risk of mortality and either (a) negatively impacts a person's daily function or quality of life and/or (b) excessively burdens their caregivers . Older adults comprise the largest population living with serious illnesses, and 9 of 10 older adults will live with one or more serious illnesses in the final year of their lives .…”

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confidence: 99%

Training Clinicians with Communication Skills Needed to Match Medical Treatments to Patient Values

Back

Fromme

Meier

2019

J American Geriatrics Society

129

111

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Most clinicians currently in practice did not receive the evidence-based communication skills training they need to provide high-quality communication for seriously ill older adults and their families. Clinician communication skills are a critical factor in achieving a patient and family understanding of their illness that enables them to share in decision making that will result in medical treatments and social supports that are aligned with their goals and values. Research demonstrates that existing clinician competence in communication skills is extremely variable, that most clinicians need specific communication training to have an adequate level of skill, and that evidence-based training is efficacious. A conservative estimate suggests that more than 219,000 physicians and advance practice providers (APPs) (50% of physicians in high-contact subspecialties and 25% of all APPs) could benefit from training. Combining evidence-based clinician training with health system workflow redesign would likely maximize the impact of this training. We conclude with recommendations designed to address gaps in communication skills through effective training and health system changes in the service of enabling all patients with serious illness and their families to receive care aligned with their personal priorities. J Am Geriatr Soc 67:S435-S441, 2019.

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“…According to the Center to Advance Palliative Care, palliative care is focused on providing relief from the symptoms and stress from serious illness with the goal of improving quality of life for both the patient and family 12 . Serious illness is defined as a condition that carries a high risk of mortality, negatively impacts quality of life and daily function, and/or is burdensome in symptoms, treatments, or caregiver stress 13 . This includes illnesses such as chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF), which are also a focus of the 2012 Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program 3…”

Section: Introductionmentioning

confidence: 99%

Medication‐related 30‐day rehospitalizations in palliative care patients

Pruskowski

Ruby

Berenbrok

et al. 2020

J Am Coll Clin Pharm

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Purpose Prior studies suggest that inpatient palliative care services can reduce rehospitalizations. However, medications commonly prescribed by palliative care providers (eg, opioids, benzodiazepines, and antipsychotics) have been independently associated with rehospitalizations. Little is known regarding the role of adverse drug reaction (ADR)‐related rehospitalizations within the palliative care population. Objective To determine the prevalence and explore predictors of ADR‐related 30‐day rehospitalizations in an inpatient palliative care population. Methods A retrospective cohort study that included 284 palliative care patients who were readmitted within 30‐days of discharge from two academic hospitals in Western Pennsylvania. All unplanned rehospitalizations were assessed for medication causality via the Naranjo algorithm by at least two independent reviewers. Results The mean (SD) age of the cohort was 61 (16) years and included 45% (n = 127) female and 81% Caucasians (n = 229). Of the 254 unplanned rehospitalizations, 11 (4%) were classified as doubtful ADRs, 224 (88%) were classified as possible ADRs, and 19 (7%) were defined as probable or definite ADR‐related. Tacrolimus was associated with three probable and one definite ADR‐related rehospitalization. Oncologic agents (eg, venetoclax, nivolumab, vincristine, and decitabine, carfilzomib; n = 5), anticoagulants (eg, rivaroxaban, apixaban, and warfarin; n = 4), antimicrobials (eg, cephalexin and vancomycin; n = 2), potassium chloride (n = 2), lorazepam (n = 1), and nicotine replacement (n = 1) were all associated with probable ADRs. Only the number of medication changes during the index admissions was observed as a statistically significant predictor of rehospitalizations in this population (P = .043). Conclusions Palliative care patients often suffer from potential ADR‐related rehospitalizations and the number of medication changes during the index hospital admissions is associated with future potential ADRs. Clinical pharmacists should consider these findings when developing initiatives to reduce rehospitalizations in the inpatient palliative care patient population.

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Defining “Serious Illness”

Cited by 102 publications

References 0 publications

Identifying the Population with Serious Illness: The “Denominator” Challenge

Identifying the Population with Serious Illness: The “Denominator” Challenge

Training Clinicians with Communication Skills Needed to Match Medical Treatments to Patient Values

Medication‐related 30‐day rehospitalizations in palliative care patients

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