Goal-Concordant Care in the Era of Advanced Stroke Therapies

Sokol, Leonard L.; Hauser, Joshua; Lum, Hillary D.; Forlizzi, Jodi; Cerf, Moran; Caprio, Fan Z.; Young, Michael J.

doi:10.1089/jpm.2019.0667

Cited by 10 publications

(6 citation statements)

References 23 publications

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“…Care consistent with the patient's goals of care is known as goal-concordant care. 7 One method proposed to prevent the provision of non-goal-concordant care, or unwanted treatment, is advance care planning (ACP). Litzelman et al 8 found that ACP facilitated by trained community health workers, among U. S. HH patients with dementia who were already frequent users of acute care, was associated with a reduction in using acute care services.…”

Section: Introductionmentioning

confidence: 99%

Advance Care Planning Protocols and Hospitalization Rates in Home Health Value-Based Purchasing

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Haddad

Ahluwalia

et al. 2021

Home Health Care Management & Practice

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Advance care planning is a conversation about personal values, future treatment choices, and designation of a surrogate decision-maker, that someone has in advance of a health crisis. Most existing studies on advance care planning have taken place outside of home health among populations with HIV/AIDS, cancer, dementia, and end stage renal disease. The U.S. home health population is living longer with chronic conditions such as pulmonary and cardiovascular illnesses, and hospitalization is a poor outcome. In 2016, Medicare implemented the Home Health Value-Based Purchasing Model, in which reimbursement rates for agencies in 9 regionally representative states were dependent on quantitative measures of quality performance. Part of the program was a process-level mandate requiring agencies to report on advance care planning. The aim of this study was to examine the relationship of home health advance care planning protocols with hospitalization rates. Descriptive and regression analyses were conducted on survey data of protocols and agency data of demographics and outcomes. Statistical significance was found in the positive correlation between advance care planning protocols and hospitalization. Recommendations are made for broadening the scope of evaluation of quality in home health to include goal-concordant care and transitions to appropriate services.

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Section: Introductionmentioning

confidence: 99%

Advance Care Planning Protocols and Hospitalization Rates in Home Health Value-Based Purchasing

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Haddad

Ahluwalia

et al. 2021

Home Health Care Management & Practice

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“…16,18,19 Recently, the potential impact of the expanded time window for advanced stroke treatment on goal-concordant care has been reviewed. 20 Most patients in this study were enrolled before the expansion of the endovascular treatment time window to 24 hours and, therefore, it is unlikely that these considerations impacted our findings.…”

Section: Discussionmentioning

confidence: 98%

Family Perceptions of Quality of End-of-Life Care in Stroke

Markovitz

Morgenstern

Shafie-Khorassani

et al. 2020

Palliative Medicine Reports

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Background: Most end-of-life decisions after stroke are made by a surrogate decision maker, yet there has been limited study of surrogate assessment of the quality of end-of-life stroke care. Objective: To assess surrogate perceptions of quality of end-of-life care (QEOLC) in stroke and explore factors associated with quality. Design: Cross-sectional analysis of interviewer-administered survey. Settings/subjects: Surrogate decision makers for deceased stroke patients in a population-based study. Measurements: The primary outcome was the validated 10-item family version of the QEOLC scale. The univariate association between prespecified patient and surrogate factors and dichotomized QEOLC score (high: 8-10, low: 0-7) was explored with logistic regression fit using generalized estimating equations. Results: Seventy-nine surrogates for 66 deceased stroke cases were enrolled (median patient age: 76, female patient: 53%, Mexican American patient: 59%, median time from stroke to death: seven days, median surrogate age: 59, and female surrogate: 72%). The overall QEOLC was generally high (median 8.3, quartiles 6.1, 9.6) although several individual items had a high proportion (*30%-50%) of surrogates who felt that the questions did not apply to the patient's situation. No hypothesized factors were associated with QEOLC score, including demographics, stroke type, location/timing of death, advance directives, health literacy, or understanding of patient wishes. Conclusions: Surrogates reported generally high QEOLC. Although this finding is encouraging, modifications to the QEOLC may be needed in stroke as some surrogates were unable to provide a valid response for certain items.

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“…Shared decision-making is central to high-quality healthcare but stroke brings additional challenges to patient participation including sudden illness, impaired communication, lack of capacity, and proxy (substitute) decision-making. 13 , 30 The devastating impact of severe stroke on the lives of patients and families globally is evident. 31 Both decision making and quality of life evolve over a stroke illness trajectory so measures for patients and proxy (substitute) decision-makers suited to early and later phases were highlighted by our panelists and key stakeholders.…”

Section: Discussionmentioning

confidence: 99%

Core Outcome Measures for Palliative and End-of-Life Research After Severe Stroke: Mixed-Method Delphi Study

Mason¹,

Boyd²,

Doubal³

et al. 2021

Stroke

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Background and Purpose: Stroke is the second commonest cause of death worldwide and a leading cause of severe disability, yet there are no published trials of palliative care in stroke. To design and evaluate palliative care interventions for people with stroke, researchers need to know what measurable outcomes matter most to patients and families, stroke professionals, and other service providers. Methods: A multidisciplinary steering group of professionals and laypeople managed the study. We synthesized recommendations from respected United Kingdom and international consensus documents to generate a list of outcome domains and then performed a rapid scoping literature review to identify potential outcome measures for use in future trials of palliative care after stroke. We then completed a 3-round, online Delphi survey of professionals, and service users to build consensus about outcome domains and outcome measures. Finally, we held a stakeholder workshop to review and finalize this consensus. Results: We generated a list of 36 different outcome domains from 4 key policy documents. The rapid scoping review identified 43 potential outcome measures that were used to create a shortlist of 16 measures. The 36 outcome domains and 16 measures were presented to a Delphi panel of diverse healthcare professionals and lay service users. Of 48 panelists invited to take part, 28 completed all 3 rounds. Shared decision-making and quality of life were selected as the most important outcome domains for future trials of palliative care in stroke. Additional comments highlighted the need for outcomes to be feasible, measurable, and relevant beyond the initial, acute phase of stroke. The stakeholder workshop endorsed these results. Conclusions: Future trials of palliative care after stroke should include pragmatic outcome measures, applicable to the evolving patient and family experiences after stroke and be inclusive of shared decision-making and quality of life.

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Goal-Concordant Care in the Era of Advanced Stroke Therapies

Cited by 10 publications

References 23 publications

Advance Care Planning Protocols and Hospitalization Rates in Home Health Value-Based Purchasing

Advance Care Planning Protocols and Hospitalization Rates in Home Health Value-Based Purchasing

Family Perceptions of Quality of End-of-Life Care in Stroke

Core Outcome Measures for Palliative and End-of-Life Research After Severe Stroke: Mixed-Method Delphi Study

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