Measures that Matter in Advanced Illness Care

by Meredith MacMartinI was drawn to the field of palliative care by something subjective, the feeling of deep satisfaction from providing goal-aligned care for my patients, and the desire to do that better. In training, I came to realize that while much of our work lies in the qualitative realm, the key to doing it better lies in the underlying structure and frame of good communication, symptom management, and care coordination. It is no surprise to me, then, that palliative care is embracing the increasing emphasis on healthcare quality and value; in other words, the quantitative measures that underlie the qualitative experience of our patients and families. I was gratified to see the number of sessions at this year’s AAHPM Annual Assembly that were focused on this topic, and was especially interested in the discussions around the less easily measured aspects of the care that we provide. Many of the metrics that have been tracked and reported in the palliative care field have focused on expenditures and resource utilization, and I for one have struggled with how to collect and organize data on the actual quality of the care I’m providing. So what does high quality palliative care look like? How do we measure quality of life parameters in an efficient and meaningful way? How do we measure the alignment of a patient’s care with his or her goals? How do we measure the ways in which we impact their experience of advanced illness?Please join NQF's National Quali...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: macmartin quality Source Type: blogs

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Exercise is beneficial for skeletal muscle functions across all ages. However, the response to exercise shifts with aging, resulting in anabolic resistance and limited gain in muscle strength and endurance. These changes likely reflect age-related alterations in transcriptional response underlying the muscular adaptation to exercise. The exact changes in gene expression accompanying exercise are largely unknown, and elucidating them is of a great clinical interest for optimizing the exercise-based therapies for sarcopenia.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Geriatric and Palliative Care Source Type: research
Telehealth has become mainstream during the COVID-19 pandemic, but its role in managing older patients is not well defined. This systematic review aims to assess the postoperative benefits of perioperative telehealth interventions in older adults.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Geriatric and Palliative Care Source Type: research
With rising life expectancy and low birth rates, elderly people make up an increasing proportion of the population of the United States. Studies estimate that by 2050, the nonagenarian population will reach 8.7 million. Elderly people have significant medical care needs and their need for surgical care will require nuanced evaluation of their surgical candidacy and operative risks.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Geriatric and Palliative Care Source Type: research
The hypoxia signaling pathway plays a pivotal role in the regulation of metabolic response during muscular adaptation to exercise. To explore the role of hypoxia signaling in exercise performance, we generated a transgenic mouse model with inducible, skeletal muscle-specific knockout of ARNT (ARNT mKO).
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Geriatric and Palliative Care Source Type: research
In this study, we identified geriatric surgical service interventions most relevant to EGS patients.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Geriatric and Palliative Care Source Type: research
Woman,over age 70, compose 30% of breast cancer cases. Over expression of HER2 occurs in 15% of cases. NCCN guidelines recommend systemic treatment for tumors over 1 cm. The Charlson Comorbidity Index can quantify multiple comorbidities and predict a limited life expectancy that allows stratification of women over age 70 who may not benefit from systemic treatment of HER2 breast cancer.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Geriatric and Palliative Care Source Type: research
The association of frailty on postoperative outcomes after elective and emergency general surgery (EGS) procedures are widely examined. However, this association has not been examined in the geriatric population stratified by EGS procedural risk.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Geriatric and Palliative Care Source Type: research
Existing injury severity metrics are insufficient to predict outcomes in older adults (age ≥65). We sought to develop and validate a new metric, the Outcome-Specific Injury Score (OSIS), as a practical tool to predict outcome-specific risks for older adults using fall-related injuries as a model.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Geriatric and Palliative Care Source Type: research
Palliative care (PC) is an essential aspect of high-quality pancreatic cancer-care, however, its national utilization is unknown. Among patients with metastatic pancreatic cancer, we sought to (1) identify factors associated with PC, and (2) assess hospital variation in utilization of PC.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Geriatric and Palliative Care Source Type: research
As the US population ages, surgeons face new questions regarding operating on older adults. However, the epidemiology of frailty among older patients undergoing hernia surgery has not been reported.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Geriatric and Palliative Care Source Type: research
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