Predictors of reliably high-value end-of-life care

Purpose of review Care near the end of life is expensive and frequently not aligned with the expressed preferences of decedents, creating an opportunity to improve value, or increase quality while lowering cost. This review examines publications from 2017 and 2018 on interventions and policies associated with high-value end-of-life care. Innovations in video and web-based advance care planning are promising to improve preference-congruent care at low cost. Recent findings The patterns of care within hospice and in particular increased investment in patient care in hospice are shown to improve value. A meta-analysis demonstrated the role of inpatient palliative care consultations in decreasing hospitalization costs, as did several studies on inpatient palliative care units. Internationally, a range of home-based palliative care programs, implemented at the population level, demonstrated cost savings and reduced intensive care near the end of life. Finally, public policies that funded medical and long-term care and address broader inequalities were demonstrated to decrease low-value care near the end of life. Summary This review demonstrates the efficacy of a range of approaches to improve value of care at the end of life, both within the health system and across public policy sectors.
Source: Current Opinion in Supportive and Palliative Care - Category: Palliative Care Tags: END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston Source Type: research

Related Links:

We present a case of a young male who experienced multiple metastases and been diagnosed HLRCC after the operation of radical nephrectomy for 10 months. This case remains us that early screening and surveillance are recommended to people who have a family history or at risk of HLRCC, surgical and palliative therapy still play an important role in clinical treatment in the meantime.
Source: Urology Case Reports - Category: Urology & Nephrology Source Type: research
BACKGROUND: Older patients with traumatic brain injury (TBI) have higher mortality and morbidity than their younger counterparts. Palliative care (PC) is recommended for all patients with a serious or life-limiting illness. However, its adoption for trauma...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Age: Elder Adults Source Type: news
Authors: Oderda GM, Senagore AJ, Morland K, Iqbal SU, Kugel M, Liu S, Habib AS Abstract Opioid-induced respiratory depression (OIRD) and postoperative nausea and vomiting (PONV) are challenging, resource-intensive, and costly opioid-related adverse events (ORAEs). Utilizing the Premier Healthcare Database, we identified patients> 18 years old, who underwent at least one surgical procedure of interest (i.e., cardiothoracic/vascular, general/colorectal, obstetric/gynecologic, orthopedic, or urologic), and received at least one dose of intravenous morphine, hydromorphone, or fentanyl for acute postoperative ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research
Authors: Bodnar J Abstract The anesthetic propofol is used in a number of medical applications including surgery, procedural sedation, refractory status epilepticus, alcohol withdrawal, and critical care sedation. The manner in which it is dosed and administered in each environment varies, tailored to the specific task at hand. Because the use of propofol in end-of-life care is uncommon, providers may lack practical experience, and resources that are specific to this specialized application are not comprehensive and largely based on dosing and administration as it is done on the intensive care unit. The purpose of ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research
This article offers therapeutic practice skills needed by social workers to address the experience of anticipatory loss in an acute care setting. Brief psychodynamic and person-centered therapy, provided in combination, are highlighted as one method to explore a patient's feelings and wishes in the face of critical illness. Case-based vignettes illustrate how five open-ended questions help mitigate suffering and heighten a patient's sense of autonomy and self-worth. PMID: 31608809 [PubMed - as supplied by publisher]
Source: Journal of Social Work in End-of-Life and Palliative Care - Category: Palliative Care Tags: J Soc Work End Life Palliat Care Source Type: research
Publication date: November–December 2019Source: Journal of Minimally Invasive Gynecology, Volume 26, Issue 7, SupplementAuthor(s): SR Pena, J Brown, M Wally, R Seymour, JR Hsu, RW NaumannStudy ObjectiveTo determine opioid and benzodiazepine prescribing practices in the gynecologic oncology population and determine if this patient population is at risk for narcotic abuse.DesignThis was an IRB-approved, retrospective study of opioid and benzodiazepine prescriptions for cervical, ovarian (including fallopian tube and primary peritoneal), and uterine cancer patients within a single healthcare system from January 2016 to ...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
ConclusionsThis case report demonstrates an unusual etiology of back and leg pain in a young man and elucidates the palliative effects of radiation therapy for epithelioid hemangioma involving the lumbar spine.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
This report presents the rationale and methodology of TRAIN-AD (Trial to reduce antimicrobial use in nursing home residents with Alzheimer ’s disease and other dementias), a parallel group, cluster RCT evaluating a multicomponent intervention to improve infection management for suspected urinary tract infections (UTIs) and lower respiratory tract infections (LRIs) among NH residents with advanced dementia. TRAIN-AD is being conducted in 28 facilities in the Boston, USA, area randomized in waves using minimization to achieve a balance on key characteristics (N = 14 facilities/arm). The involvement of the...
Source: Trials - Category: Research Source Type: clinical trials
Journal of Palliative Medicine, Ahead of Print.
Source: Journal of Palliative Medicine - Category: Palliative Care Authors: Source Type: research
Journal of Palliative Medicine, Ahead of Print.
Source: Journal of Palliative Medicine - Category: Palliative Care Authors: Source Type: research
More News: Intensive Care | Palliative | Palliative Care | Study