scholarly journals Downstream Effects of End-of-Life Care for Older Adults with Serious Illness on Health Care Utilization of Family Caregivers

2015 ◽  
Vol 18 (9) ◽  
pp. 736-737 ◽  
Author(s):  
Katherine A. Ornstein ◽  
Kathrin Boerner ◽  
Albert L. Siu ◽  
Richard Schulz
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Family Caregivers ◽  
End Of Life Care ◽  
Care Utilization ◽  
Life Care ◽  
Serious Illness ◽  
Downstream Effects

Trends in Health-Care Utilization at the End of Life Among Patients With Hematologic Malignancies in a Middle-Income Country: Challenges and Opportunities in Brazil

2019 ◽  
Vol 36 (9) ◽  
pp. 775-779 ◽  
Author(s):  
Luiz Guilherme L. Soares ◽  
Renato Vieira Gomes ◽  
André M. Japiassu
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
End Of Life Care ◽  
Hematologic Malignancies ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Blood Transfusions ◽  
Life Care ◽  
To Receive

Patients with hematologic malignancies (HMs) often receive poor-quality end-of-life care. This study aimed to identify trends in end-of-life care among patients with HM in Brazil. We conducted a retrospective cohort study (2015-2018) of patients who died with HM, using electronic medical records linked to health insurance databank, to evaluate outcomes consistent with health-care resource utilization at the end of life. Among 111 patients with HM, in the last 30 days of life, we found high rates of emergency department visits (67%, n = 75), intensive care unit admissions (56%, n = 62), acute renal replacement therapy (10%, n = 11), blood transfusions (45%, n = 50), and medical imaging utilization (59%, n = 66). Patients received an average of 13 days of inpatient care and the majority of them died in the hospital (53%, n = 58). We also found that almost 40% of patients (38%, n = 42) used chemotherapy in the last 14 days of life. These patients were more likely to be male (64% vs 22%; P < .001), to receive blood transfusions (57% vs 38%; P = .05), and to die in the hospital (76% vs 39%; P = .009) than patients who did not use chemotherapy in the last 14 days of life. This study suggests that patients with HM have high rates of health-care utilization at the end of life in Brazil. Patients who used chemotherapy in the last 14 days of life were more likely to receive blood transfusions and to die in the hospital.

scholarly journals Health care utilization and end-of-life care for older patients with acute myeloid leukemia

Cancer ◽  
2015 ◽  
Vol 121 (16) ◽  
pp. 2840-2848 ◽  
Author(s):  
Areej R. El-Jawahri ◽  
Gregory A. Abel ◽  
David P. Steensma ◽  
Thomas W. LeBlanc ◽  
Amir T. Fathi ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Myeloid Leukemia ◽  
Health Care Utilization ◽  
End Of Life ◽  
End Of Life Care ◽  
Older Patients ◽  
Myeloid Leukemia ◽  
Care Utilization ◽  
Life Care ◽  
Acute Myeloid

scholarly journals Health Care Utilization and End-of-Life Care Outcomes for Patients With Decompensated Cirrhosis Based on Transplant Candidacy

2020 ◽  
Vol 59 (3) ◽  
pp. 590-598 ◽  
Author(s):  
Nneka N. Ufere ◽  
Jennifer L. Halford ◽  
Joshua Caldwell ◽  
Min Young Jang ◽  
Sunil Bhatt ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
End Of Life Care ◽  
Decompensated Cirrhosis ◽  
Care Utilization ◽  
Life Care ◽  
Care Outcomes

Health care utilization and end of life care in patients with primary malignant brain tumors.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e14072-e14072
Author(s):  
Sunil Mahesh Bhatt ◽  
Areej El-Jawahri ◽  
Ryan David Nipp ◽  
Tracy Batchelor ◽  
Jennifer S. Temel ◽  
...  
Keyword(s):  
Health Care ◽  
Brain Tumors ◽  
Health Care Utilization ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Utilization ◽  
Life Care ◽  
Malignant Brain Tumors

Health care utilization and patient-related outcomes in patients with malignant bowel obstruction admitted to a United States safety net hospital.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 50-50
Author(s):  
Vijaya Venkatasubbaraya Pavan Kedar Vijaya Venkatasubbar Mukthinuthalapati ◽  
Aakash Putta ◽  
Ishaan Vohra ◽  
Vatsala Katiyar ◽  
Krishna Moturi ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Surgical Management ◽  
End Of Life Care ◽  
Safety Net ◽  
Care Utilization ◽  
Life Care ◽  
Malignant Bowel Obstruction ◽  
Safety Net Hospital

50 Background: Malignant bowel obstruction (MBO) and gastric outlet obstruction (GOO) can be a late complication of intra-abdominal malignancy with a poor prognosis. Most studies about its outcomes have focused on survival. There is paucity of studies assessing health care utilization and end of life care decisions. Methods: We retrospectively collected data from the electronic medical record of patients admitted with MBO or GOO at a safety-net hospital in Chicago, US between January 2013 and December 2017. The charts were analyzed for outcomes related to end of life care and health care utilization. The outcomes were compared by across three broad treatment arms: those that received surgical intervention, those that received venting gastrostomy (VG) and those that were treated medically alone. Results: Forty-six patients were identified of which 31 were admitted with MBO. 25 (54%) of them were due to stage IV cancers. Mean age of study population was 61 years. Surgical management, VG and medical management were done in 17, 8 and 21 patients respectively. There was no difference in ICU admission rate, length of stay of index admission, 90 day-readmission rate or mean visits to the ER between the groups. Patients receiving venting gastrostomy tube had highest rate of oral solid food tolerability. Twenty-eight patients died or were enrolled in hospice within a median of 115 days. Conclusions: All modalities of treatment had similar health utilization measures in patients with MBO and GOO. Surgical management, if feasible, has the longest time to hospice enrollment or death and should be offered to patients who are suitable. [Table: see text]

scholarly journals Lower Extremity Amputation and Health Care Utilization in the Last Year of Life among Medicare Beneficiaries with ESRD

2019 ◽  
Vol 30 (3) ◽  
pp. 481-491 ◽  
Author(s):  
Catherine R. Butler ◽  
Margaret L. Schwarze ◽  
Ronit Katz ◽  
Susan M. Hailpern ◽  
William Kreuter ◽  
...  
Keyword(s):  
Health Care ◽  
Lower Extremity ◽  
End Of Life ◽  
End Of Life Care ◽  
Lower Extremity Amputation ◽  
Care Utilization ◽  
Life Care ◽  
Medicare Beneficiaries ◽  
Care Needs ◽  
Extremity Amputation

BackgroundLower extremity amputation is common among patients with ESRD, and often portends a poor prognosis. However, little is known about end-of-life care among patients with ESRD who undergo amputation.MethodsWe conducted a mortality follow-back study of Medicare beneficiaries with ESRD who died in 2002 through 2014 to analyze patterns of lower extremity amputation in the last year of life compared with a parallel cohort of beneficiaries without ESRD. We also examined the relationship between amputation and end-of-life care among the patients with ESRD.ResultsOverall, 8% of 754,777 beneficiaries with ESRD underwent at least one lower extremity amputation in their last year of life compared with 1% of 958,412 beneficiaries without ESRD. Adjusted analyses of patients with ESRD showed that those who had undergone lower extremity amputation were substantially more likely than those who had not to have been admitted to—and to have had prolonged stays in—acute and subacute care settings during their final year of life. Amputation was also associated with a greater likelihood of dying in the hospital, dialysis discontinuation before death, and less time receiving hospice services.ConclusionsNearly one in ten patients with ESRD undergoes lower extremity amputation in their last year of life. These patients have prolonged stays in acute and subacute health care settings and appear to have limited access to hospice services. These findings likely signal unmet palliative care needs among seriously ill patients with ESRD who undergo amputation as well as opportunities to improve their care.

scholarly journals End-of-Life Plans for African American Older Adults With Dementia

2018 ◽  
Vol 35 (10) ◽  
pp. 1314-1322 ◽  
Author(s):  
Karen O. Moss ◽  
Nancy L. Deutsch ◽  
Patricia J. Hollen ◽  
Virginia G. Rovnyak ◽  
Ishan C. Williams ◽  
...  
Keyword(s):  
Older Adults ◽  
African American ◽  
End Of Life ◽  
Family Caregivers ◽  
End Of Life Care ◽  
Life Care ◽  
Life Planning ◽  
Care Recipients ◽  
Life Plans ◽  
End Of Life Planning

African Americans are perceived to be least likely of all racial and ethnic groups to prepare for the end of life. However, verbal plans for the end of life are of particular importance to this population and may help understand why they are less likely to possess a formal end-of-life care planning document. The purpose of this study was to determine the number of formal and/or informal end-of-life care plans that existed among a convenience sample of African American older adults with dementia. For this descriptive study, data were collected from African American family caregivers (N = 65) of older adults with dementia. Descriptive statistics were conducted. Caregivers in this sample reported high rates of formal and/or informal end-of-life plans for their care recipients. Agency forms (power of attorney, health-care surrogate, or guardianship forms) had been obtained by 74% of the care recipients, while 63% of them possessed a formal end-of-life care planning document. All combined, 88% of the caregivers possessed at least 1 document or verbal information concerning end-of-life care for their care recipient or at least there was an assigned surrogate. Although limited, these findings reflect more end-of-life planning in this population than previous studies reported and could improve the quality of end-of-life outcomes in this population by giving health-care providers increased understanding of African American end-of-life planning preferences. This may, in turn, help the providers to inform and educate these care recipients and their family caregivers.

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