scholarly journals Unplanned hospitalizations for metastatic cancers: The changing patterns of inpatient palliative care, discharge to hospice care, and in-hospital mortality in the United States

2017 ◽  
Vol 5 (1) ◽  
pp. 13-28 ◽  
Author(s):  
Jason L. Salemi ◽  
Charles C. Chima ◽  
Kiara K. Spooner ◽  
Roger J. Zoorob
Keyword(s):  
United States ◽  
Palliative Care ◽  
Hospital Mortality ◽  
Hospice Care ◽  
The United States ◽  
Changing Patterns ◽  
Unplanned Hospitalizations

High–Tech, Aggressive Palliative Care: In the Service of Quality of Life

1993 ◽  
Vol 9 (1) ◽  
pp. 37-41 ◽  
Author(s):  
David M. Dush
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Health Care ◽  
Palliative Care ◽  
Hospice Care ◽  
High Technology ◽  
The United States ◽  
High Tech ◽  
Hospice Movement

The hospice movement grew in part as a reaction to the perception that modern medical care had become too technological at the expense of being impersonal and insensitive to human psychological and spiritual concerns. In the United States, the institutionalization of hospice care under Medicare and other reimbursement systems has further established hospice as an alternative to high-technology, high-cost care. The present paper examines the question: What if hospice care becomes itself high-technology, aggressive, costly health care in order to remain true to its goal of maximizing quality of life? Implications for the goals and philosophical underpinnings of palliative care are discussed.

Hospice Approach to Palliative Care

2018 ◽  
Author(s):  
Sriram Yennurajalingam
Keyword(s):  
United States ◽  
Palliative Care ◽  
Social Work ◽  
Physical Therapy ◽  
Life Expectancy ◽  
End Of Life ◽  
Nursing Care ◽  
Hospice Care ◽  
The United States ◽  
Medicare Part

For the provision of palliative care in the hospice setting in the United States, Medicare covers any care that is reasonable and necessary to manage palliative and hospice care at end of life. To be eligible for this Medicare hospice benefit, a beneficiary must be entitled to Medicare Part A and be certified by a physician to have a life expectancy of 6 months or less if the illness runs its expected course. Medicare covers medications, nursing care, and medical services including care by a physician, physical therapy, social work. This chapter briefly reviews the various aspects of the Medicare hospice benefit.

scholarly journals Palliative Care and Hospice: A Paradigm for End-of-Life Care in Developing Nations

2017 ◽  
Vol 6 (2) ◽  
pp. 38-44 ◽  
Author(s):  
Peter A. Clark
Keyword(s):  
United States ◽  
Palliative Care ◽  
End Of Life Care ◽  
Hospice Care ◽  
The United States ◽  
Developing Nations ◽  
Comfort Care ◽  
Loved One ◽  
Legal Perspective ◽  
Fear Of Abandonment

Traditionally, medical care has had two mutually exclusive goals: either to cure disease and to prolong life or to provide comfort care. Given this dichotomy, the decision to focus on reducing suffering is made usually only after life-prolonging treatment has been ineffectual and death is imminent, usually by days or hours. As a result, one of the best kept secrets in a hospital today in the United States is palliative care and hospice care. We estimate that of the 2.4 million Americans that die each year, about 80% end their lives in hospitals attached to the latest advances in technology; 300,000 die at home under hospice care. The reasons why more people do not receive palliative or hospice care range from the patient’s fear of abandonment and the unknown, the family’s denial of the inevitability of death of their loved one, and physician’s denial of medicine’s limitations. Unless the options of palliative or hospice care are given to patients the fears that people have of dying--fear of dying alone and fear of dying in pain--will continue to make the dying process one that lacks dignity and respect. In this review article we have reviewed the state of palliative and hospice care in the United States through a historical, ethical and legal perspective. We have discussed its scope in the developing world and the potential challenges.Journal of Advances in Internal Medicine 2017;06(02):38-44.

Racial/ethnic disparities in hospital utilization in intracerebral hemorrhage

2019 ◽  
Vol 14 (7) ◽  
pp. 686-695 ◽  
Author(s):  
Salvador Cruz-Flores ◽  
Gustavo J Rodriguez ◽  
Mohammad Rauf A Chaudhry ◽  
Ihtesham A Qureshi ◽  
Mohtashim A Qureshi ◽  
...  
Keyword(s):  
United States ◽  
Palliative Care ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Pacific Islander ◽  
The United States ◽  
Hospital Utilization ◽  
Hospital Charges ◽  
Do Not Resuscitate ◽  
Vp Shunt

Background and purpose There is evidence that racial and ethnic differences among intracerebral hemorrhage (ICH) patients exist. We sought to establish the occurrence of disparities in hospital utilization in the United States. Methods We identified ICH patients from United States Nationwide Inpatient Sample database for years 2006–2014 using codes (DX1 = 431, 432.0) from the International Classification of Diseases, 9th edition. We compared five race/ethnic categories: White, Black, Hispanic, Asian or Pacific Islander, and Others ( Native American and other) with regard to demographics, comorbidities, disease severity, in-hospital complications, in-hospital procedures, length of stay (LOS), total hospital charges, in-hospital mortality, palliative care, (PC) and do not resuscitate (DNR). We categorized procedures as lifesaving (i.e. ventriculostomy, craniotomy, craniectomy, and ventriculoperitoneal (VP) shunt), life sustaining (i.e. mechanical ventilation, tracheostomy, transfusions, and gastrostomy). White race/ethnicity was set as the reference group. Results Out of 710,293 hospitalized patients with ICH 470,539 (66.2%), 114,821 (16.2%), 66,451 (9.3%), 30,297 (4.3%) and 28,185 (3.9%) were White, Black, Hispanic, Asian or Pacific Islander, and Others, respectively. Minorities (Black, Hispanic, Asian or Pacific Islander, and Others) had a higher rate of in-hospital complications, in-hospital procedures, mean LOS, and hospital charges compared to Whites. In contrast, Whites had a higher rate of in-hospital mortality, PC, and DNR. In multivariable analysis, all minorities had higher rate of MV, tracheostomy, transfusions, and gastrostomy compared to Whites, while Hispanics had higher rate of craniectomy and VP shunt; and Asian or Pacific Islander and Others had higher rate of craniectomy. Whites had a higher rate of in-hospital mortality, palliative care, and DNR compared to minorities. In mediation analysis, in-hospital mortality for whites remained high after adjusting with PC and DNR. Conclusion Minorities had greater utilization of lifesaving and life sustaining procedures, and longer LOS. Whites had greater utilization of palliative care, hospice, and higher in-hospital mortality. These results may reflect differences in culture or access to care and deserve further study.

A Systematic Review on Barriers to Palliative Care in Oncology

2021 ◽  
pp. 104990912098328
Author(s):  
Jyotsana Parajuli ◽  
Judith E. Hupcey
Keyword(s):  
United States ◽  
Systematic Review ◽  
Palliative Care ◽  
Full Text ◽  
Literature Search ◽  
Intervention Development ◽  
The United States ◽  
Care Utilization ◽  
Review Of Literature ◽  
Meta Analyses

The number of people with cancer and the need for palliative care among this population is increasing in the United States. Despite this growing need, several barriers exist to the utilization of palliative care in oncology. The purpose of this study was to synthesize the evidence on the barriers to palliative care utilization in an oncology population. A systematic review of literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, and Psych Info databases were used for the literature search. Articles were included if they: 1) focused on cancer, (2) examined and discussed barriers to palliative care, and c) were peer reviewed, published in English, and had an accessible full text. A total of 29 studies (8 quantitative, 18 qualitative, and 3 mixed-methods) were identified and synthesized for this review. The sample size of the included studies ranged from 10 participants to 313 participants. The barriers to palliative care were categorized into barriers related to the patient and family, b) barriers related to providers, and c) barriers related to the healthcare system or policy. The factors identified in this review provide guidance for intervention development to mitigate the existing barriers and facilitate the use palliative care in individuals with cancer.

scholarly journals Palliative Care in Advanced Dementia: Comparison of Strategies in Three Countries

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 44
Author(s):  
Shelley A. Sternberg ◽  
Shiri Shinan-Altman ◽  
Ladislav Volicer ◽  
David J. Casarett ◽  
Jenny T. van der Steen
Keyword(s):  
Palliative Care ◽  
The Netherlands ◽  
Hospice Care ◽  
The United States ◽  
Artificial Nutrition ◽  
Advanced Dementia ◽  
Case Scenario ◽  
Artificial Nutrition And Hydration ◽  
Positive Elements ◽  
The Us

Palliative care including hospice care is appropriate for advanced dementia, but policy initiatives and implementation have lagged, while treatment may vary. We compare care for people with advanced dementia in the United States (US), the Netherlands, and Israel. We conducted a narrative literature review and expert physician consultation around a case scenario focusing on three domains in the care of people with advanced dementia: (1) place of residence, (2) access to palliative care, and (3) treatment. We found that most people with advanced dementia live in nursing homes in the US and the Netherlands, and in the community in Israel. Access to specialist palliative and hospice care is improving in the US but is limited in the Netherlands and Israel. The two data sources consistently showed that treatment varies considerably between countries with, for example, artificial nutrition and hydration differing by state in the US, strongly discouraged in the Netherlands, and widely used in Israel. We conclude that care in each country has positive elements: hospice availability in the US, the general palliative approach in the Netherlands, and home care in Israel. National Dementia Plans should include policy regarding palliative care, and public and professional awareness must be increased.

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