scholarly journals Place of Death and End-of-Life Care Utilization among COVID-19 Decedents in a Massachusetts Health Care System

2020 ◽  
Author(s):  
Isaac S. Chua ◽  
Sandra M. Shi ◽  
David M. Levine
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care System ◽  
End Of Life Care ◽  
Place Of Death ◽  
Care Utilization ◽  
Life Care ◽  
Care System

scholarly journals End-of-Life Care for Patients With Advanced Kidney Disease in the US Veterans Affairs Health Care System, 2000-2011

2018 ◽  
Vol 72 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Susan P.Y. Wong ◽  
Margaret K. Yu ◽  
Pamela K. Green ◽  
Chuan-Fen Liu ◽  
Paul L. Hebert ◽  
...  
Keyword(s):  
Health Care ◽  
Kidney Disease ◽  
End Of Life ◽  
Health Care System ◽  
End Of Life Care ◽  
Veterans Affairs ◽  
Life Care ◽  
The Us ◽  
Us Veterans ◽  
Care System

scholarly journals Palliative and End-of-Life Care in the Home in Regional/Rural Victoria, Australia: The Role and Lived Experience of Primary Carers

2021 ◽  
Vol 7 ◽  
pp. 237796082110362
Author(s):  
Elizabeth M. Miller ◽  
Joanne E. Porter ◽  
Rebecca Peel
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Lived Experience ◽  
End Of Life ◽  
Health Care System ◽  
End Of Life Care ◽  
Primary Health Care System ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Care System

Introduction Palliative support services (generalist or specialist) can provide much-needed assistance to carers who are providing palliative and end-of-life care in their homes, but access to such services in regional and rural areas of Australia is poorly understood. Objectives This study aimed to explore the role and lived experience of primary carers who are providing palliative and end-of-life care in the home in regional/rural Victoria, Australia. Methods Nine female participants, of whom six were bereaved between 7 and 20 months were interviewed using a semistructured interview technique. Each interview was audio-recorded, transcribed verbatim, and analyzed thematically. Results Two themes emerged: “ Negotiating healthcare systems” which described the needs for multidisciplinary supports and “ The caring experience” which discussed daily tasks, relationships, mental and physical exhaustion, respite, isolation, medication management, and grief and loss. Findings show that regional/rural carers have an added burden of travel stress as well as feeling overwhelmed, isolated, and physically and emotionally exhausted. Carers would benefit from greater flexibility for short-term respite care. The engagement of specialist palliative care services assisted the participants to navigate the health care system. Some participants did not understand the value of palliative care, highlighting the need for general practitioners to conduct early conversations about this with their patients. Education is needed to build capacity within the primary palliative care workforce, confirming the importance of timely referrals to a specialist palliative care practitioner if pain or symptom control is not effectively managed. Conclusion Providing palliative and end-of-life care in the home is an exhausting and emotionally draining role for unpaid, primary carers. Multiple supports are needed to sustain primary carers, as they play an essential role in the primary health care system.

scholarly journals Health Care System Distrust, Race, and Surrogate Decision Making Regarding Code Status

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Sang Yoon Na, BS, MS ◽  
James E. Slaven, MS ◽  
Emily S. Burke, BA ◽  
Alexia M. Torke, MD, MS
Keyword(s):  
Health Care ◽  
African American ◽  
End Of Life ◽  
Health Care System ◽  
End Of Life Care ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Surrogate Decision ◽  
Care System

Background and Hypothesis: Studies have shown African American patients are more likely to prefer aggressive life-sustaining treatments such as cardiopulmonary resuscitation (CPR) at end-of-life compared to non-Hispanic White patients. Given prior racial disparities in healthcare, low trust has been proposed to explain these preferences. We examined factors that influence surrogate decision makers’ preference for Do Not Resuscitate (DNR) status for hospitalized older adults who cannot make their own medical decisions. We explored whether race is associated with surrogate preference for DNR status for a hospitalized older adult. We also examine if race is associated with distrust and if the race/code status relationship is partially explained (mediated) by distrust in the healthcare system. Experimental Design or Project Methods: Analyses were conducted using data from an observational study of patient/surrogate dyads admitted to an ICU in a Midwest metropolitan area. Distrust was assessed using the Revised Health Care System Distrust Scale. A single item asked the surrogate which status they thought was best for the patient, full code or DNR. Results: In bivariate analysis, higher proportion of African American surrogates showed preference for full code (62.4% vs 37.6%, p=0.0001). After adjusting for trust and sociodemographic and psychological covariates, race was still significantly associated with DNR preference (aOR = 1.92; 95% CI: 1.04, 3.55; p=0.0382). Surrogate race did not show significant association with distrust in bivariate or multivariable analysis, which adjusted for sociodemographic and psychological covariates (p=0.3867). Conclusion and Potential Impact: Contrary to previous studies, we observed no association between surrogate race and distrust of the health care system. Differences in code status preference may be due to other factors related to race and culture. In order to ensure patients are receiving end-of-life care that is consistent with their values, more work is needed to understand the cultural complexities behind end-of-life care preference.

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 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 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
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