Evaluation of Prognostic Criteria for Determining Hospice Eligibility in Patients With Advanced Lung, Heart, or Liver Disease

Abstract

These data indicate that for seriously ill hospitalized patients with advanced chronic obstructive pulmonary disease, congestive heart failure, or end-stage liver disease, recommended clinical prediction criteria are not effective in identifying a population with a survival prognosis of 6 months or less.

Assessing the Impact of Screening Colonoscopy on Mortality in the Medicare Population

“…Prior analyses have not considered that the impact of cancer on a patient's risk of death may be diminished among patients with higher comorbidity 11,12 . Further, while prior work has stratified patients into life expectancy groups, comorbidity was not incorporated into the approach [13][14][15][16][17][18] . Finally, prior work has not accounted for the fact that increasing age and declining health would increase one's susceptibility to the risk of SC-associated complications 11,12 .…”

“Serious and complex illness” in quality improvement and policy reform for end-of-life care

“…7 Nonhematologic malignancies such as lung and colon cancer most commonly follow this course. 6 At least two thirds of us will die at the end of a very different course. 7 We will have 1 or more serious chronic diseases Ð heart, lung, or cognitive failure are most common.…”

“…10,11 The distinction is an important one from a public policy standpoint: many entire illness types, such as heart failure, would not qualify under some interpretations of the 6-month rule though they would often qualify under others. 6 The diagnosis of``terminal'' often carries with it the implication that the end of life is approaching and the focus turns to attending to completion of life tasks, spiritual issues, and physical comfort 12 Ð all of which are important concerns and extremely appropriate for that population for whom nothing more can be done. But there is a different set of individuals Ð those with``serious and complex'' illness Ð who have the disease(s) from which they are likely to die but are not in the last few weeks and months of life.…”

“…Organ system failures, such as heart failure, cirrhosis, and obstructive lung disease, are also heavily treated in``medical'' systems and the costs are borne largely by Medicare. However, organ system failure patients ordinarily cannot use hospice 6 or any other service customized to provide good home support at the end of life. For those afflicted with strokes or dementia, the bulk of the care needs fall outside of a``medical'' reimbursement model and these individuals are forced to rely much more upon personal assets, family, and Medicaid.…”

“…Recognition of this population's special characteristics could help to organize knowledge and administer benefits.`S erious and complex (and eventually fatal)'' illness seems more appropriate for most uses than is the phrasè`t erminally ill,'' which is a quite ambiguous and restrictive category, though commonly used. 5,6``S erious and complex'' conditions are seriously disabling and will worsen until death. Virtually all such conditions require complex organizing of services over time.…”