Patterns of care at end of life for people with primary intracranial tumors: lessons learned

Alturki, Abdulrahman Y.; Gagnon, Bruno; Petrecca, Kevin; Scott, Susan C.; Nadeau, Lucie; Mayo, Nancy E.

doi:10.1007/s11060-014-1360-2

Cited by 18 publications

(19 citation statements)

References 55 publications

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“…In comparison, in the US Medicare population, 18% of the beneficiaries underwent surgical procedures [ 42 ], and 24% and 9% of patients with cancer were admitted to ICUs and received life-sustaining treatment [including intubation, feeding tube placement, and cardiopulmonary resuscitation (CPR)], respectively, during the last month of their life [ 43 ]. Moreover, studies in other countries on patients with cancer have revealed consistently lower EOL surgical rates [ 44 , 45 ] and utilization of ICU, mechanical ventilation, and resuscitation [ 33 , 46 – 48 ] than those observed in our study population. In Taiwan, patents with cancer also had lower EOL care intensity: 11% with ICU admission, 29% with mechanical ventilation and 11% with CPR [ 35 ].…”

Section: Discussionsupporting

confidence: 60%

Costs of care at the end of life among elderly patients with chronic kidney disease: patterns and predictors in a nationwide cohort study

Chen¹,

Fan

Chou

et al. 2017

BMC Nephrol

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BackgroundDespite the urgent need for evidence to guide the end-of-life (EOL) care for patients with chronic kidney disease (CKD), we have limited knowledge of the costs and intensity of EOL care in this population. The present study examined patterns and predictors for EOL care intensity among elderly patients with CKD.MethodsWe conducted a retrospective nationwide cohort study utilizing the Taiwan National Health Insurance (NHI) Research Database. A total of 65,124 CKD patients aged ≥ 60 years, who died in hospitals or shortly after discharge between 2002 and 2012 were analyzed. The primary outcomes were inpatient expenses and use of surgical interventions in the last 30 days of life. Utilization of intensive care unit (ICU), mechanical ventilation, resuscitation, and dialysis was also examined in a sub-sample of 2072 patients with detailed prescription data. Multivariate log-linear and logistic regression analyses were performed to assess patient-, physician-, and facility-specific predictors and the potential impact of a 2009 payment policy to reimburse hospice care for non-cancer patients.ResultsDuring the last 30 days of life, average inpatients costs for elderly CKD patients were approximately US$10,260, with 40.9% receiving surgical interventions, 40.2% experiencing ICU admission, 45.3% undergoing mechanical ventilation, 14.7% receiving resuscitation and 42.0% receiving dialysis. Significant variability was observed in the inpatient costs and use of intensive services. Costs were lower among individuals with the following characteristics: advanced age; high income; high Charlson Comorbidity Index scores; treatment by older physicians, nephrologists, and family medicine physicians; and treatment at local hospitals. Similar findings were obtained for the use of surgical interventions and other intensive services. A declining trend was detected in the costs of EOL care, use of surgical interventions and resuscitation between 2009 and 2012, which is consistent with the impact of a 2009 NHI payment policy to reimburse non-cancer hospice care.ConclusionsOverall EOL costs and rates of intensive service use among older patients with CKD were high, with significant variability across various patient and provider characteristics. Several opportunities exist for providers and policy makers to reduce costs and enhance the value of EOL care for this population.

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Section: Discussionsupporting

confidence: 60%

Costs of care at the end of life among elderly patients with chronic kidney disease: patterns and predictors in a nationwide cohort study

Chen¹,

Fan

Chou

et al. 2017

BMC Nephrol

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“…Given the importance of home health care, market demand is likely to increase, and its function could expand; if so, new quality of care indicators would be indicated. For example, home health care may play an important role in the provision of in‐home palliative care, which has been associated with less symptom burden and greater patient and caregiver satisfaction …”

Section: Discussionmentioning

confidence: 99%

“…For example, home health care may play an important role in the provision of in-home palliative care, which has been associated with less symptom burden and greater patient and caregiver satisfaction. 8,[35][36][37][38][39][40] The relationship between the quality and the availability or use of home health care is unclear. Regions that have good availability of home health services may not necessarily receive high-quality care.…”

Section: Discussionmentioning

confidence: 99%

Home Health Agency Performance in the United States: 2011–15

Wang

Spatz

Tariq

et al. 2017

J American Geriatrics Society

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OBJECTIVES To evaluate home health agency quality performance. DESIGN Observational study. SETTING Home health agencies PARTICIPANTS All Medicare-certified agencies with at least 6 months of data from 2011 to 2015. MEASUREMENTS Twenty-two quality indicators, five patient survey indicators, and their composite scores. RESULTS The study included 11,462 Medicare-certified home health agencies that served 92.4% of all ZIP codes nationwide, accounting for 315.2 million people. The mean composite scores were 409.1 ± 22.7 out of 500 with the patient survey indicators and 492.3 ± 21.7 out of 600 without the patient survey indicators. Home health agency performance on 27 quality indicators varied, with the coefficients of dispersion ranging from 4.9 to 62.8. Categorization of agencies into performance quartiles revealed that 3,179 (27.7%) were in the low-performing group (below 25th percentile) at least one time during the period from 2011–12 to 2014–15 and that 493 were in the low-performing group throughout the study period. Geographic variation in agency performance was observed. Agencies with longer Medicare-certified years were more likely to have high-performing scores; agencies providing partial services, with proprietary ownership, and those with long travel distances to reach patients had lower performance. Agencies serving low-income counties and counties with lower proportions of women and senior residences and greater proportions of Hispanic residents were more likely to attain lower performance scores. CONCLUSION Home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance. Still, there is a need to improve the quality of care of all agencies. Many parts of the United States, particularly lower-income areas and areas with more Hispanic residents, are more likely to receive lower quality home health care.

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“…Unfortunately, we were not able to distinguish patients whose death was preceded by a clinical state characterized by metastatic cancer and slow deterioration before death from those who died from complications of cancer treatment at an early (but not late) stage. 45 …”

Section: Discussionmentioning

confidence: 99%

“…Former research has shown that it is feasible to assess intensity of care at the end-of-life using routine claims and further administrative databases. 3 , 7 , 18 – 20 …”

Section: Study Aimsmentioning

confidence: 99%

Intensity of treatment in Swiss cancer patients at the end-of-life

Bähler¹,

Signorell²,

Blozik³

et al. 2018

CMAR

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PurposeCurrent evidence on the care-delivering process and the intensity of treatment at the end-of-life of cancer patients is limited and remains unclear. Our objective was to examine the care-delivering processes in health care during the last months of life with real-life data of Swiss cancer patients.Patients and methodsThe study population consisted of adult decedents in 2014 who were insured at Helsana Group. Data on the final cause of death were provided additionally by the Swiss Federal Statistical Office. Of the 10,275 decedents, 2,710 (26.4%) died of cancer. Intensity of treatment and health care utilization (including transitions) at their end-of-life were examined. Intensity measures included the following: last dose of chemotherapy within 14 days of death, a new chemotherapy regimen starting <30 days before death, more than one hospital admission or spending >14 days in hospital in the last month, death in an acute care hospital, more than one emergency visit and ≥1 intensive care unit admission in the last month of life.ResultsIn the last 6 months of life, 89.5% of cancer patients had ≥1 transition, with 87.2% being hospitalized. Within 30 days before death, 64.2% of the decedents had ≥1 intensive treatment, whereby 8.9% started a new chemotherapy. In the multinomial logistic regression model, older age, higher density of nursing home beds and home care nurses were associated with a decrease, while living in the Italian- or French-speaking part of Switzerland was associated with an increase in intensive care.ConclusionSwiss cancer patients insured by Helsana Group experience a considerable number of transitions and intensive treatments at the end-of-life, whereby treatment intensity declines with increasing age. Among others, increased home care nursing might be helpful to reduce unwarranted treatments and transitions, therefore leading to better care at the end-of-life.

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Patterns of care at end of life for people with primary intracranial tumors: lessons learned

Cited by 18 publications

References 55 publications

Costs of care at the end of life among elderly patients with chronic kidney disease: patterns and predictors in a nationwide cohort study

Costs of care at the end of life among elderly patients with chronic kidney disease: patterns and predictors in a nationwide cohort study

Home Health Agency Performance in the United States: 2011–15

Intensity of treatment in Swiss cancer patients at the end-of-life

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