Proactive Case Finding To Improve Concurrently Curative and Palliative Care in Patients with End-Stage Liver Disease

Walling, Anne M.; Schreibeis-Baum, Hannah; Pimstone, Neville R.; Asch, Steven M.; Robinson, Linda; Korlekar, Sheri; Lorenz, Karl; Nwajuaku, Tracy; Rosenfeld, Kenneth

doi:10.1089/jpm.2014.0265

Cited by 20 publications

(22 citation statements)

References 15 publications

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“…A few small studies have explored methods for integrating palliative care earlier in the care of patients with end-stage liver disease 29-31 ; however, guidelines regarding when to consider palliative care are needed. Our finding that transplantation listing or receipt is associated with lower odds of receiving inpatient palliative care mirrors findings from a previous study demonstrating an association between liver transplantation status and poorer end-of-life care quality 32 .…”

Section: Discussionmentioning

confidence: 99%

Palliative Care and Health Care Utilization for Patients With End-Stage Liver Disease at the End of Life

Patel

Walling

Ricks-Oddie

et al. 2017

Clinical Gastroenterology and Hepatology

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120

142

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Background & Aims There has been increased attention on ways to improve the quality of end of life care for patients with end-stage liver disease, yet there have been few reports of care experiences for patients during terminal hospitalizations. We analyzed data from a large national database to increase our understanding of palliative care for and healthcare utilization by patients with end-stage liver disease. Methods We performed a cross-sectional, observational study to examine terminal hospitalizations of adults with decompensated cirrhosis using data from the National Inpatient Sample, from 2009 through 2013. We collected data on palliative care consultation and total hospital costs, and performed multivariate regression analyses to identify factors associated with palliative care consultation. We also investigated whether consultation was associated with lower costs. Results Of 59,687 hospitalized adults with terminal decompensated cirrhosis; 29.1% received palliative care; the mean cost per hospitalization was $49,167±$1169. Palliative care consultation increased annually, provided to 17.8% of patients in 2009 and 35.4% of patients in 2013 (P<.05). The mean cost for the terminal hospitalization also increased each year, from $47,766 in 2009 to $51,435 in 2013 (P<.05). African Americans, Hispanics, Asians, and liver transplant candidates were less likely to receive palliative care, whereas care in large, urban, teaching hospitals was associated with higher odds of receiving consultation. Palliative care was associated with lower procedure burden—after adjusting for other factors, palliative care was associated with cost reduction of $8892. Conclusion Palliative care consultation and cost of end of life care for patients with end-stage liver disease increased from 2009 through 2013. Palliative care consultation during terminal hospitalizations is associated with lower costs and procedure burden. Future research should evaluate timing and effects of palliative care on quality of end of life care in this population.

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Section: Discussionmentioning

confidence: 99%

Palliative Care and Health Care Utilization for Patients With End-Stage Liver Disease at the End of Life

Patel

Walling

Ricks-Oddie

et al. 2017

Clinical Gastroenterology and Hepatology

Self Cite

120

142

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“…While concurrent palliative and hepatology care for patients on the waiting list has been described as feasible and effective, palliative care consults are rare even for patients denied transplant listing . Another strategy that has proven effective in the pre‐transplant setting is care coordination, which significantly increased transplant candidacy in one center (78% vs 31%) . Given the significant overlap between the experience of pain and psychiatric symptoms in the setting of cirrhosis, optimizing psychiatric management is certainly an important component of pain control.…”

Section: Discussionmentioning

confidence: 99%

Association between opioid use and readmission following liver transplantation

Rogal

Mankaney

Udawatta

et al. 2016

Clinical Transplantation

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The aim of this study was to assess the independent association between pre-transplant prescription opioid use and readmission following liver transplantation. We reviewed the medical records of all patients at a single medical center undergoing primary, single-organ, liver transplantation from 2004 to 2014. We assessed factors associated with hospital readmission 30 days and 1 year after hospital discharge using multivariable competing risk regression models. Among 1056 transplant recipients, 49 (4.6%) were prescribed pre-transplant prescription opioids. Readmission occurred in 421 (40%) patients within 30 days and 689 (65%) within 1 year. Patients with pre-transplant opioid use had a significantly higher risk of readmission at 30 days (HR 1.7; 95% CI 1.1-2.5) and a non-significantly elevated risk at 1 year (HR 1.4; 95% CI 1.0-1.9) when controlling for other potential confounders. Although pain was the major reason for readmission in only 12 (3%) patients at 30 days and 33 (6%) patients at 1 year, pre-transplant opioid use was significantly associated with pain-related readmission at both time points. In conclusion, prescription opioid use pre-transplantation was significantly associated with all-cause 30-day readmissions and pain-related readmissions at 30 days and 1 year.

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“…A quality improvement study in a Veterans Affairs setting, designed to proactively identify patients with a Model for ESLD (MELD) score ≥ 14 and/or hepatocellular carcinoma (HCC); patients were referred for a PC consultation through a care coordinator. ( 43 ) The results showed that PC consultations improved the likelihood of being considered for LT and the likelihood of completing the transplantation evaluations. Telehealth could potentially be used to integrate PC within LT care, as has shown to work within liver practices.…”

Section: Structures and Processes Required For Integrating Nonhospicementioning

confidence: 96%

Nonhospice Palliative Care Within the Treatment of End‐Stage Liver Disease

2020

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Palliative care (PC) that has evolved from a focus on end-of-life care to an expanded form of holistic care at an early stage for patients with serious illnesses and their families is commonly referred to as nonhospice PC (or early PC). Patients with end-stage liver disease (ESLD) suffer from a high symptom burden and a deteriorated quality of life (QOL), with uncertain prognosis and limited treatment options. Caregivers of these patients also bear an emotional and physical burden similar to that of caregivers for patients with cancer. Despite the proven benefits of nonhospice PC for other serious illnesses and cancer, there are no evidence-based structures and processes to support its integration within the routine care of patients with ESLD and their caregivers. In this article, we review the current state of PC for ESLD and propose key structures and processes to integrate nonhospice PC within routine hepatology practice. Results found that PC is highly underutilized within ESLD care, and limited prospective studies are available to demonstrate methods to integrate PC within routine hepatology practices. Hepatology providers report lack of training to deliver PC along with no clear prognostic criteria on when to initiate PC. A well-informed model with key structures and processes for nonhospice PC integration would allow hepatology providers to improve clinical outcomes and QOL for patients with ESLD and reduce health care costs. Educating hepatology providers about PC principles and developing clear prognostic criteria for when and how to integrate PC on the basis of individual patient needs are the initial steps to inform the integration. The fields of nonhospice PC and hepatology have ample opportunities to partner clinically and academically. (Hepatology 2020;71:2149-2159). E nd-stage liver disease (ESLD) is the 12th leading cause of death and claims approximately 66,000 lives each year in the United States. (1) Between 2006 and 2016, the prevalence of ESLD increased by 7.9% among men 25-34 years of age and 11.4% among women in the same age group because of the increasing burden of nonalcoholic steatohepatitis, alcohol-associated liver disease, and advanced hepatitis C virus. (2) In parallel, mortality due to ESLD increased by 65% from 1999 to 2016. (3) ESLD is also associated with functional and cognitive impairment, often with concomitant mental health and substance use disorders. The physical and psychological symptom burden and social-role consequences of ESLD are often worse than those for many non-liver cancers. (4) The most frequently reported symptoms include pain, breathlessness, muscle cramps, sleep disturbance, fatigue, pruritus, anxiety, depression, and erectile dysfunction. (4) In addition to its direct effects on patients, ESLD is linked with a substantial caregiver emotional and physical burden, mirroring that observed in caregivers of patients with cancer. (5) However, interventions to improve the quality of life (QOL) for patients with ESLD and their caregivers are underdeveloped.Palliativ...

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Proactive Case Finding To Improve Concurrently Curative and Palliative Care in Patients with End-Stage Liver Disease

Cited by 20 publications

References 15 publications

Palliative Care and Health Care Utilization for Patients With End-Stage Liver Disease at the End of Life

Palliative Care and Health Care Utilization for Patients With End-Stage Liver Disease at the End of Life

Association between opioid use and readmission following liver transplantation

Nonhospice Palliative Care Within the Treatment of End‐Stage Liver Disease

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