Integrating Palliative Care into the Chronic Illness Continuum: a Conceptual Model for Minority Populations

Gazaway, Shena; Stewart, Merry; Schumacher, Autumn

doi:10.1007/s40615-019-00610-y

Cited by 14 publications

(19 citation statements)

References 27 publications

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“…32,64,65 This finding is consistent with results from a recent propensity score-matched study of seriously-ill Black/African American and White patients from the same dataset, which found PCC was associated with 14-to 15-fold increases in hospice enrollment for both Black/African American and White patients compared to clinically similar Black/African American and White patients without PCC. 32 Previous studies suggest patient-centered PCC communication benefits patients across racial and ethnic groups, [66][67][68] but qualitative research is needed to understand why PCC is associated with racially similar hospice enrollment and if PCC mitigates disparities in hospice care. Consistent with recommended standards for publishing on health inequities, 44 we defined race and ethnicity as socialcultural factors, not biological factors, and acknowledged how institutional and interpersonal racism experienced by ethnic minority patients may explain differences in outcomes.…”

Section: Discussionmentioning

confidence: 99%

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Starr

Ulrich

Pérez

et al. 2021

Am J Hosp Palliat Care

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Background: Palliative care consultation to discuss goals-of-care (“PCC”) may mitigate end-of-life care disparities. Objective: To compare hospitalization and cost outcomes by race and ethnicity among PCC patients; identify predictors of hospice discharge and post-discharge hospitalization utilization and costs. Methods: This secondary analysis of a retrospective cohort study assessed hospice discharge, do-not-resuscitate status, 30-day readmissions, days hospitalized, ICU care, any hospitalization cost, and total costs for hospitalization with PCC and hospitalization(s) post-discharge among 1,306 Black/African American, Latinx, White, and Other race PCC patients at a United States academic hospital. Results: In adjusted analyses, hospice enrollment was less likely with Medicaid (AOR = 0.59, P = 0.02). Thirty-day readmission was less likely among age 75+ (AOR = 0.43, P = 0.02); more likely with Medicaid (AOR = 2.02, P = 0.004), 30-day prior admission (AOR = 2.42, P < 0.0001), and Black/African American race (AOR = 1.57, P = 0.02). Future days hospitalized was greater with Medicaid (Coefficient = 4.49, P = 0.001), 30-day prior admission (Coefficient = 2.08, P = 0.02), and Black/African American race (Coefficient = 2.16, P = 0.01). Any future hospitalization cost was less likely among patients ages 65-74 and 75+ (AOR = 0.54, P = 0.02; AOR = 0.53, P = 0.02); more likely with Medicaid (AOR = 1.67, P = 0.01), 30-day prior admission (AOR = 1.81, P = 0.0001), and Black/African American race (AOR = 1.40, P = 0.02). Total future hospitalization costs were lower for females (Coefficient = −3616.64, P = 0.03); greater with Medicaid (Coefficient = 7388.43, P = 0.01), 30-day prior admission (Coefficient = 3868.07, P = 0.04), and Black/African American race (Coefficient = 3856.90, P = 0.04). Do-not-resuscitate documentation (48%) differed by race. Conclusions: Among PCC patients, Black/African American race and social determinants of health were risk factors for future hospitalization utilization and costs. Medicaid use predicted hospice discharge. Social support interventions are needed to reduce future hospitalization disparities.

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Section: Discussionmentioning

confidence: 99%

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Starr

Ulrich

Pérez

et al. 2021

Am J Hosp Palliat Care

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“…The study data were used to develop a preliminary conceptual model of oral health service delivery in the YK Delta (Figure ). A number of existing models describe factors that predict use of health care services, the most relevant of which is Andersen and Aday's behavioural model. The model developed in the current study shares elements with Andersen's most recent version, including an emphasis on the recursive aspects of health service use, particularly in terms of how health outcomes can influence subsequent use of care .…”

Section: Discussionmentioning

confidence: 99%

Provider and community perspectives of dental therapists in Alaska’s Yukon‐Kuskokwim Delta: A qualitative programme evaluation

Donald

Hopkins

Zahlis

et al. 2019

Comm Dent Oral Epid

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Objectives: Dental therapists deliver preventive and basic restorative care and have been practicing since 2006 in Alaska's Yukon-Kuskokwim (YK) Delta. In this qualitative programme evaluation, we documented health providers' and community members' experiences with dental therapy. The goal of the evaluation was to develop a conceptual model of dental care delivery in Alaska Native Communities centred on dental therapists. Methods:We developed semi-structured interview scripts and used snowball sampling to recruit 16 health providers with experience providing care in the YK Delta and 125 community members from six YK Delta Communities in 2017 and 2018.The six communities were a stratified convenience sample based on community-level exposure to dental therapists (high, medium and no exposure). Interview data were digitally recorded, transcribed, verified for accuracy and coded inductively into conceptual domains using content analytic methods. Results: Providers believed individuals living in the YK Delta have benefited fromclinic-based restorative care and community-based education provided by dental therapists. The restricted scope of dental therapy practice limits the complexity of care that may be offered to patients. However, community members expressed high satisfaction with the quality of care provided by dental therapists. Community members noted more widespread knowledge and evolving norms about oral health and believed dental therapists are helping to prevent disease and improve quality of life.Participants believed access to dental care for children has improved over the years, but felt that many adults in the YK Delta continue to have unmet needs. A potential barrier to sustained programme effectiveness is low retention of dental therapists in the region, driven primarily by reports that dental therapists feel overworked, stressed and geographically isolated.Conclusions: Dental therapists have contributed to the dental care delivery system in Alaska's YK Delta. Future opportunities remain within the system to address the needs of adults, develop strategies to retain dental therapists in the region and incorporate evidence-based, prevention-oriented strategies to improve oral health behaviours and reduce oral diseases. | 503CHI et al.

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“…Other models have integrated palliative care into a serious illness framework without including a focus on MCC. [12][13][14][15] Hodiamont and colleagues 16 explored the concept of complexity, as it relates to palliative care to describe resulting needs and care demands associated with an individual's clinical complexity by describing a "complex adaptive system" consisting of physical, psychospiritual, and sociocultural subsystems. 16 The aforementioned models all provide conceptualization of care or research involving palliative care, serious illness, or MCC.…”

Section: Introductionmentioning

confidence: 99%

An Adapted Conceptual Model Integrating Palliative Care in Serious Illness and Multiple Chronic Conditions

Murali¹,

Merriman²,

Yu³

et al. 2020

Am J Hosp Palliat Care

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Objective: Seriously ill adults with multiple chronic conditions (MCC) who receive palliative care may benefit from improved symptom burden, health care utilization and cost, caregiver stress, and quality of life. To guide research involving serious illness and MCC, palliative care can be integrated into a conceptual model to develop future research studies to improve care strategies and outcomes in this population. Methods: The adapted conceptual model was developed based on a thorough review of the literature, in which current evidence and conceptual models related to serious illness, MCC, and palliative care were appraised. Factors contributing to patients’ needs, services received, and service-related variables were identified. Relevant patient outcomes and evidence gaps are also highlighted. Results: Fifty-eight articles were synthesized to inform the development of an adapted conceptual model including serious illness, MCC, and palliative care. Concepts were organized into 4 main conceptual groups, including Factors Affecting Needs (sociodemographic and social determinants of health), Factors Affecting Services Received (health system; research, evidence base, dissemination, and health policy; community resources), Service-Related Variables (patient visits, service mix, quality of care, patient information, experience), and Outcomes (symptom burden, quality of life, function, advance care planning, goal-concordant care, utilization, cost, death, site of death, satisfaction). Discussion: The adapted conceptual model integrates palliative care with serious illness and multiple chronic conditions. The model is intended to guide the development of research studies involving seriously ill adults with MCC and aid researchers in addressing relevant evidence gaps.

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Integrating Palliative Care into the Chronic Illness Continuum: a Conceptual Model for Minority Populations

Cited by 14 publications

References 27 publications

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Provider and community perspectives of dental therapists in Alaska’s Yukon‐Kuskokwim Delta: A qualitative programme evaluation

An Adapted Conceptual Model Integrating Palliative Care in Serious Illness and Multiple Chronic Conditions

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