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Topics
- Adverse Drug Events (ADE) (1)
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- Cancer: Prostate Cancer (1)
- Caregiving (3)
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- Critical Care (1)
- Decision Making (1)
- Disparities (2)
- Education: Continuing Medical Education (1)
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- (-) Palliative Care (31)
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- Provider: Nurse (1)
- Quality Indicators (QIs) (1)
- Quality Measures (4)
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- Racial and Ethnic Minorities (2)
- Research Methodologies (1)
- Sex Factors (1)
- Telehealth (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 31 Research Studies DisplayedWu A, Ugiliweneza B, Wang D
Trends and outcomes of early and late palliative care consultation for adult patients with glioblastoma: a seer-Medicare retrospective study.
This study investigates differences in palliative care (PC) timing on outcomes for patients with glioblastoma (GBM) using Surveillance, Epidemiology, and End Results (SEER) Medicare data. Findings showed that, despite an overall increase in PC consultations, only a minority of GBM patients receive PC. Patients with late PC had the longest survival times and had greater hospice use in the last month of life compared to other subgroups.
AHRQ-funded; HS028747.
Citation: Wu A, Ugiliweneza B, Wang D .
Trends and outcomes of early and late palliative care consultation for adult patients with glioblastoma: a seer-Medicare retrospective study.
Neurooncol Pract 2022 Aug;9(4):299-309. doi: 10.1093/nop/npac026.
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Keywords: Palliative Care, Cancer, Quality of Life, Healthcare Costs
Jin MC, Hsin G, Ratliff J
Modifiers of and disparities in palliative and supportive care timing and utilization among neurosurgical patients with malignant central nervous system tumors.
This study analyzed a cohort of privately insured patients with malignant brain or spinal tumors derived from the Optum Clinformatics Datamart Database to investigate health disparities and access and utilization of palliative care and supportive services. The authors introduced a novel construct, “provider patient racial diversity index” (provider pRDI) which is a measure of the proportion of non-white minority patients a provider encounters to approximate a provider's patient demographics and suggest a provider's cultural sensitivity and exposure to diversity. Their analysis demonstrated low rates of palliative care, home health, and social work services among racial minority patients, with Hispanics having the lowest likelihood of engagement with all three categories of supportive services. Patients who saw providers categorized into high provider pRDI (categories II and III) were increasingly more likely to interface with supportive care services and at an earlier point in their disease courses.
AHRQ-funded; HS028747.
Citation: Jin MC, Hsin G, Ratliff J .
Modifiers of and disparities in palliative and supportive care timing and utilization among neurosurgical patients with malignant central nervous system tumors.
Cancers 2022 May 23;14(10). doi: 10.3390/cancers14102567..
Keywords: Palliative Care, Disparities, Cancer
Temkin-Greener H, Guo W, Hua Y
End-of-life care in assisted living communities: race and ethnicity, dual enrollment status, and state regulations.
The purpose of this study was to evaluate the relationships between death at home and home hospice care with race, ethnicity, community characteristics, strictness of state-level regulations for assisted living facilities, dual Medicare-Medicaid enrollment, and other individual characteristics. The researchers found that almost 60% of the 100,783 fee-for-service Medicare beneficiaries residing in 16,560 assisted living communities who died in 2018-2019, died at home. Of those individuals, 84% were with home hospice care. Dual Medicare-Medicaid enrollment was a more important predictor of death at home than race or ethnicity; yet race was a stronger predictor than dual enrollment for hospice care at death. In states with lower regulatory strictness for assisted living communities, residents were less likely to die at home. The study concludes that these results imply an important role for state regulation of assisted living facilities and can help guide efforts to ensure equitable access to the individual’s preference for end-of-life-care.
Citation: Temkin-Greener H, Guo W, Hua Y .
End-of-life care in assisted living communities: race and ethnicity, dual enrollment status, and state regulations.
Health Aff 2022 May;41(5):654-62. doi: 10.1377/hlthaff.2021.01677..
Keywords: Elderly, Palliative Care, Long-Term Care, Racial and Ethnic Minorities
Washington KT, Kukulka K, Govindarjan R
Engaging specialist palliative care in the management of amyotrophic lateral sclerosis: a patient-, family-, and provider-based approach.
Investigators sought to describe key stakeholders' perspectives on specialist palliative care and its integration into the management of amyotrophic lateral sclerosis (ALS). Individual interviews were conducted with 42 stakeholders; the interview transcriptions were analyzed using inductive thematic analysis techniques. The investigators found that stakeholders expressed limited or inaccurate understandings of palliative care's definition and purpose. Stakeholders generally supported the integration of specialist palliative care into ALS management and recognized the value of early integration of palliative services in both the community and the clinical setting.
AHRQ-funded; HS022140.
Citation: Washington KT, Kukulka K, Govindarjan R .
Engaging specialist palliative care in the management of amyotrophic lateral sclerosis: a patient-, family-, and provider-based approach.
J Palliat Care 2022 Apr;37(2):170-76. doi: 10.1177/0825859719895827..
Keywords: Palliative Care, Neurological Disorders
Gray NA, Kamal AH, Hanson LC
Clinician perspectives guiding approach to comprehensiveness of palliative care assessment.
This paper discusses the results of a two-part web-based survey of palliative care clinicians from five academic groups in the United States. The objective was to describe clinicians’ assessment practices and factors influencing their approach to quality palliative care in contrast to the National Consensus Project guidelines for palliative care. Nineteen out of 25 invited clinicians completed the survey, including physicians, nurse practitioners, and physician assistants. The majority (62%) reported that their usual practice was to tailor the focus of the consultation, mainly due to time limitations and workload, followed by beliefs that comprehensive assessment was unnecessary, and absence of the full interdisciplinary team. Most participants cited reason for consult as factors influencing a tailored approach. Physical symptoms were the most commonly assessed factor (81%), with spiritual and cultural factors least commonly (24% and 19%, respectively) listed. Although most clinicians reported usually tailoring their consultations, mean importance scores for almost all assessment elements were high (mean of 7.1 on a 0-9 importance scale).
AHRQ-funded; HS022763.
Citation: Gray NA, Kamal AH, Hanson LC .
Clinician perspectives guiding approach to comprehensiveness of palliative care assessment.
J Palliat Med 2022 Feb;25(2):307-11. doi: 10.1089/jpm.2021.0391..
Keywords: Palliative Care, Provider: Nurse
Dionne-Odom JN, Wells RD, Guastaferro K
An early palliative care telehealth coaching intervention to enhance advanced cancer family caregivers' decision support skills: the CASCADE pilot factorial trial.
The purpose of this study was to evaluate the feasibility, acceptability, and efficacy of the modules of a telehealth palliative care decision support training program (CASCADE training- CAre Supporters Coached to be Adept DEcision Partners) for caregivers of cancer patients. The researchers conducted a pilot trial between October 2019 and October 2020 in which 46 dyads of newly diagnosed cancer patients and their caregivers were randomized and assigned to one of eight experimental conditions. Each experimental condition included a combination of one of three CASCADE modules. Measures of decision support and caregiver and patient distress, training feasibility, and training acceptability were collected. The study found that the individual CASCADE modules were reported to have a possible benefit for decision support and caregiver distress, and that the average caregiver rating for recommending the program was 9.9 on a scale of 1(Not at all likely) to 10 (Extremely likely). The study concluded that the pilot trial was a success and justify and warrant a full-scale trial.
AHRQ-funded; HS013852.
Citation: Dionne-Odom JN, Wells RD, Guastaferro K .
An early palliative care telehealth coaching intervention to enhance advanced cancer family caregivers' decision support skills: the CASCADE pilot factorial trial.
J Pain Symptom Manage 2022 Jan;63(1):11-22. doi: 10.1016/j.jpainsymman.2021.07.023..
Keywords: Palliative Care, Cancer, Telehealth, Health Information Technology (HIT), Caregiving
Chyr LC, DeGroot L, Waldfogel JM
Implementation and effectiveness of integrating palliative care into ambulatory care of noncancer serious chronic illness: mixed methods review and meta-analysis.
The purpose of this study was to assess the implementation of models for integrating palliative care into ambulatory care for adults with noncancer serious chronic illness. Between January 2000 to May 2020, the researchers reviewed 3 electronic databases and included qualitative, mixed methods studies, and randomized and nonrandomized controlled trial studies. Quantitative analysis included 14 studies of 2,934 US adult patients. The study found that when compared to usual care the models assessed were not more effective for improving patient health-related quality of life (HRQOL) or for patient depressive symptom scores. Qualitative analysis included 5 studies of 146 patients. There was variance in patient preferences for appropriate timing of palliative care; barriers to implementation included costs, additional visits, and travel. The researchers concluded that models were not more effective than usual care for improving HRQOL or depressive symptom scores and may have little to no effect on decreasing overall symptom burden but were more effective for increasing AD documentation.
AHRQ-funded; 2902015000061
Citation: Chyr LC, DeGroot L, Waldfogel JM .
Implementation and effectiveness of integrating palliative care into ambulatory care of noncancer serious chronic illness: mixed methods review and meta-analysis.
Ann Fam Med 2022 Jan-Feb;20(1):77-83. doi: 10.1370/afm.2754..
Keywords: Chronic Conditions, Palliative Care, Implementation, Patient-Centered Healthcare, Quality of Life
Marcus KL, Kao PC, Ma C
Symptoms and suffering at end of life for children with complex chronic conditions.
The objective of this study was to evaluate symptoms and suffering at end of life for children with noncancer, noncardiac complex chronic conditions (CCCs), as well as parental distress related to their child’s suffering. Nearly one-third of bereaved parents of children with CCCs who completed the survey reported high suffering in their child's final days of life. Parental preparedness was associated with lower perceived suffering. The authors concluded that future research should target symptoms contributing to parent and child distress and assess whether enhancing parent preparedness reduces perceived child suffering.
AHRQ-funded; HS022986.
Citation: Marcus KL, Kao PC, Ma C .
Symptoms and suffering at end of life for children with complex chronic conditions.
J Pain Symptom Manage 2022 Jan; 63(1):88-97. doi: 10.1016/j.jpainsymman.2021.07.010..
Keywords: Children/Adolescents, Chronic Conditions, Palliative Care, Pain
LeBlanc TW, Ritchie CS, Friedman F
Adherence to measuring what matters items when caring for patients with hematologic malignancies versus solid tumors.
The authors sought to assess adherence to Measuring What Matters (MWM) measures by palliative care clinicians caring for patients with hematologic malignancies, compared to those with solid tumors. They found that MWM adherence regarding symptom assessment and meeting emotional needs was lower for patients with hematologic malignancies compared to those with solid tumors. They concluded that this finding suggests two key areas for quality improvement initiatives in palliative care for patients with hematologic malignancies.
AHRQ-funded; HS023681; HS022763.
Citation: LeBlanc TW, Ritchie CS, Friedman F .
Adherence to measuring what matters items when caring for patients with hematologic malignancies versus solid tumors.
J Pain Symptom Manage 2016 Dec;52(6):775-82. doi: 10.1016/j.jpainsymman.2016.09.004.
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Keywords: Cancer, Quality of Care, Palliative Care, Patient-Centered Outcomes Research, Quality Measures
Wang SY, Aldridge MD, Canavan M
Continuous home care reduces hospice disenrollment and hospitalization after hospice enrollment.
The purpose of this paper is to identify hospice and patient characteristics associated with the use of continuous home care (CHC) and to examine the associations between CHC utilization and hospice disenrollment or hospitalization after hospice enrollment. The researchers found that patients who were white, had cancer, and had more comorbidities were more likely to use CHC and that patients who used CHC were less likely to have hospice disenrollment and less likely to be hospitalized after hospice enrollment.
AHRQ-funded; HS023900.
Citation: Wang SY, Aldridge MD, Canavan M .
Continuous home care reduces hospice disenrollment and hospitalization after hospice enrollment.
J Pain Symptom Manage 2016 Dec;52(6):813-21. doi: 10.1016/j.jpainsymman.2016.05.031.
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Keywords: Elderly, Home Healthcare, Hospitalization, Palliative Care
Quinn M, Gephart S
Evidence for implementation strategies to provide palliative care in the neonatal intensive care unit.
The authors sought to answer the clinical question: In neonatal intensive care, what evidence can be used to guide implementation of palliative care protocols? They found that successful team approaches included standardized order sets to initiate neonatal palliative care (NPC), NPC education for staff, and references to NPC guidelines or protocols.They recommended that barriers such as lack of interdisciplinary cooperation, lack of appropriate physical space, and lack of education be addressed during program development.
AHRQ-funded; HS022908.
Citation: Quinn M, Gephart S .
Evidence for implementation strategies to provide palliative care in the neonatal intensive care unit.
Adv Neonatal Care 2016 Dec;16(6):430-38. doi: 10.1097/anc.0000000000000354.
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Keywords: Evidence-Based Practice, Neonatal Intensive Care Unit (NICU), Newborns/Infants, Palliative Care
Perone JA, Riall TS, Olino K
Palliative care for pancreatic and periampullary cancer.
This article summarizes surgical, endoscopic, and other palliative techniques for relief of obstructive jaundice, relief of duodenal or gastric outlet obstruction, and relief of pain due to invasion of the celiac plexus. It also introduces the utility of the palliative care triangle in clarifying a patient's and family's goals to guide decision making.
AHRQ-funded; HS022134.
Citation: Perone JA, Riall TS, Olino K .
Palliative care for pancreatic and periampullary cancer.
Surg Clin North Am 2016 Dec;96(6):1415-30. doi: 10.1016/j.suc.2016.07.012.
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Keywords: Cancer, Palliative Care, Pain, Decision Making
Wysham NG, Hochman MJ, Wolf SP
Performance of consultative palliative care model in achieving quality metrics in the ICU.
The purpose of this paper was to assess adherence to proposed quality metrics of ICU-based palliative care by palliative care specialists. The authors found that palliative care consultations in an ICU setting are characterized by variable adherence to candidate ICU palliative care quality metrics. Although symptom management was the foremost reason for palliative care consultation, consultants infrequently documented symptom assessments. The consultants performed better in offering spiritual support and managing documented symptoms.
AHRQ-funded; HS023681.
Citation: Wysham NG, Hochman MJ, Wolf SP .
Performance of consultative palliative care model in achieving quality metrics in the ICU.
J Pain Symptom Manage 2016 Dec;52(6):873-77. doi: 10.1016/j.jpainsymman.2016.05.026.
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Keywords: Critical Care, Intensive Care Unit (ICU), Palliative Care, Quality of Care, Quality Measures
Jones CA, Acevedo J, Bull J
Top 10 tips for using advance care planning codes in palliative medicine and beyond.
This article highlights 10 tips to effectively using the new advance care planning codes reimbursable under Medicare and addresses the importance of documentation, proper billing, and nuances regarding coding.
AHRQ-funded; HS023681.
Citation: Jones CA, Acevedo J, Bull J .
Top 10 tips for using advance care planning codes in palliative medicine and beyond.
J Palliat Med 2016 Dec;19(12):1249-53. doi: 10.1089/jpm.2016.0202.
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Keywords: Medicare, Palliative Care
Kavalieratos D, Corbelli J, Zhang D
Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis.
This review sought to determine the association of palliative care with quality of life (QOL), symptom burden, survival, and other outcomes for people with life-limiting illness and for their caregivers. It concluded that the association between palliative care and QOL was attenuated but remained statistically significant whereas the association with symptom burden was not statistically significant . There was no association between palliative care and survival.
AHRQ-funded; HS022989.
Citation: Kavalieratos D, Corbelli J, Zhang D .
Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis.
JAMA 2016 Nov 22;316(20):2104-14. doi: 10.1001/jama.2016.16840.
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Keywords: Caregiving, Palliative Care, Quality of Life, Patient-Centered Outcomes Research
Hochman MJ, Kamal AH, Wolf SP
Anticholinergic drug burden in noncancer versus cancer patients near the end of life.
This article's objective is to determine anticholinergic load (ACL) and its impact in noncancer versus cancer palliative care patients. The authors concluded that ACL is associated with worse fatigue and quality of life and may not differ significantly between cancer and noncancer patients nearing end of life. Symptom management drugs are more responsible for ACL in cancer and noncancer patients, although disease management drugs contribute significantly to ACL in the latter group. They recommend more attention to reducing anticholinergic use in all patients with life-limiting illness.
AHRQ-funded; HS023681.
Citation: Hochman MJ, Kamal AH, Wolf SP .
Anticholinergic drug burden in noncancer versus cancer patients near the end of life.
J Pain Symptom Manage 2016 Nov;52(5):737-43.e3. doi: 10.1016/j.jpainsymman.2016.03.020.
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Keywords: Adverse Drug Events (ADE), Cancer, Medication, Palliative Care, Quality of Life
Wang SY, Hall J, Pollack CE
Associations between end-of-life cancer care patterns and Medicare expenditures.
The authors examined the extent to which patterns of intensive end-of-life care explain geographic variation in end-of-life care expenditures among cancer decedents. The mean expenditure per cancer decedent in the last month of life was $10,800, with considerable variation in the percentage of decedents receiving intensive end-of-life care intervention. Regional patterns of late chemotherapy or late hospice use explained only approximately 1% of the expenditure difference, while the proportion of decedents who had ICU admissions within 30 days of death was a major driver of variation, explaining 37.6% of the expenditure difference. They concluded that promoting appropriate end-of-life care has the potential to reduce geographic variation in end-of-life care expenditures.
AHRQ-funded; HS023900.
Citation: Wang SY, Hall J, Pollack CE .
Associations between end-of-life cancer care patterns and Medicare expenditures.
J Natl Compr Canc Netw 2016 Aug;14(8):1001-8.
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Keywords: Cancer, Elderly, Healthcare Costs, Medicare, Palliative Care
Just E, Casarett DJ, Asch DA
Differences in terminal hospitalization care between U.S. men and women.
The authors sought to determine whether men and women receive different care during terminal hospitalizations by examining sex-based differences in lengths of stay, resuscitation status, and intensive interventions and processes of care. They found that. compared with men, women had slightly shorter hospitalizations and were more likely to have a do-not-resuscitate order. Women remained less likely to receive care in an intensive care unit, cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, or surgical procedures. The researchers concluded that men who die in hospitals receive more aggressive care than women.
AHRQ-funded; HS018425.
Citation: Just E, Casarett DJ, Asch DA .
Differences in terminal hospitalization care between U.S. men and women.
J Pain Symptom Manage 2016 Aug;52(2):205-11. doi: 10.1016/j.jpainsymman.2016.01.013.
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Keywords: Disparities, Palliative Care, Hospitalization, Sex Factors, Elderly
Kavalieratos D, Rollman BL, Arnold RM
Homeward Bound, not hospital rebound: how transitional palliative care can reduce readmission.
Comment on a study concerning heart failure palliative care interventions.
AHRQ-funded; HS022989.
Citation: Kavalieratos D, Rollman BL, Arnold RM .
Homeward Bound, not hospital rebound: how transitional palliative care can reduce readmission.
Heart 2016 Jul 15;102(14):1079-80. doi: 10.1136/heartjnl-2016-309385.
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Keywords: Heart Disease and Health, Hospital Discharge, Hospital Readmissions, Palliative Care
Hochman MJ, Wolf S, Zafar SY
Comparing unmet needs to optimize quality: characterizing inpatient and outpatient palliative care populations.
The researchers compared the unmet needs of palliative care patients by location of care to better characterize these populations. They found that outpatients are more burdened by pain at first palliative care encounter compared to inpatients, yet outpatients experience higher quality of life and better performance status.
AHRQ-funded; HS023681.
Citation: Hochman MJ, Wolf S, Zafar SY .
Comparing unmet needs to optimize quality: characterizing inpatient and outpatient palliative care populations.
J Pain Symptom Manage 2016 Jun;51(6):1033-39.e3. doi: 10.1016/j.jpainsymman.2015.12.338.
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Keywords: Quality of Care, Inpatient Care, Ambulatory Care and Surgery, Palliative Care, Patient-Centered Outcomes Research
Kamal AH, Anderson WG, Boss RD
The Cambia Sojourns Scholars Leadership Program: project summaries from the inaugural scholar cohort.
The Cambia Health Foundation designed the Sojourns Scholar Leadership Program to facilitate leadership development among budding palliative care leaders. This paper presents the background, aims, and results to date of each of the projects from the scholars of the inaugural cohort.
AHRQ-funded; HS023681.
Citation: Kamal AH, Anderson WG, Boss RD .
The Cambia Sojourns Scholars Leadership Program: project summaries from the inaugural scholar cohort.
J Palliat Med 2016 Jun;19(6):591-600. doi: 10.1089/jpm.2016.0086.
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Keywords: Healthcare Delivery, Education: Continuing Medical Education, Palliative Care, Training
Wysham NG, Kamal AH
Integrating palliative care in the intensive care unit. evidence gaps and quality gaps.
The authors discuss Mularski and colleagues in the same issue, stating that this study provides an important advancement in measuring palliative care quality in the ICU. They commend Mularski and colleagues for advancing the candidate measures of ICU-based palliative care and conclude that this report draws attention to important and persistent deficiencies in comprehensive, patient-centered critical care delivery that needs to be addressed in research and in practice.
AHRQ-funded; HS023681.
Citation: Wysham NG, Kamal AH .
Integrating palliative care in the intensive care unit. evidence gaps and quality gaps.
Ann Am Thorac Soc 2016 May;13(5):595-7. doi: 10.1513/AnnalsATS.201601-061ED.
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Keywords: Evidence-Based Practice, Intensive Care Unit (ICU), Palliative Care, Patient-Centered Outcomes Research, Quality of Care
Kamal AH, Dionne-Odom JN
A Blue Ocean strategy for palliative care: focus on family caregivers.
The authors argue that there is an undeniable societal need (or high consumer value) for some entity to ensure that family caregivers stay healthy not only so they can provide the best care possible to patients, but also for their own sake. They believe palliative care should rise to meet this societal need and take on family caregivers as a new focus of its specialized care.
AHRQ-funded; HS023681.
Citation: Kamal AH, Dionne-Odom JN .
A Blue Ocean strategy for palliative care: focus on family caregivers.
J Pain Symptom Manage 2016 Mar;51(3):e1-3. doi: 10.1016/j.jpainsymman.2015.12.305.
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Keywords: Palliative Care, Caregiving, Quality of Life, Healthcare Delivery
Kamal AH, Bull J, Ritchie CS
Adherence to measuring what matters measures using point-of-care data collection across diverse clinical settings.
The purpose of this paper was to evaluate the implementation of Measuring What Matters (MWM) measures by exploring documentation of quality measure adherence across six diverse clinical settings inherent to palliative care practice. The authors found that the lowest adherence involved comprehensive assessments during the first visit in hospitalized patients in the intensive care unit and that the highest adherence across all settings involved documentation of management of moderate to severe pain. They recommended additional studies for better understanding of benchmarks and acceptable ranges for adherence tailored to various clinical settings.
AHRQ-funded; HS023681; HS022763.
Citation: Kamal AH, Bull J, Ritchie CS .
Adherence to measuring what matters measures using point-of-care data collection across diverse clinical settings.
J Pain Symptom Manage 2016 Mar;51(3):497-503. doi: 10.1016/j.jpainsymman.2015.12.313.
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Keywords: Quality Measures, Palliative Care, Patient-Centered Outcomes Research, Quality of Care, Patient Safety
Wang SY, Hall J, Pollack CE
Trends in end-of-life cancer care in the Medicare program.
The researchers sought to examine contemporary trends in end-of-life cancer care and geographic variation of end-of-life care aggressiveness among Medicare beneficiaries. They found that the proportion of beneficiaries receiving at least one potentially aggressive end-of-life intervention increased in repeated hospitalization, repeated ED visits, ICU admissions, and late hospice enrollment but declined in in-hospital death. End-of-life chemotherapy use did not change significantly over time. They concluded that despite growing focus on providing appropriate end-of-life care, there has not been an improvement in aggressive end-of-life cancer care in the Medicare program.
AHRQ-funded; HS023900.
Citation: Wang SY, Hall J, Pollack CE .
Trends in end-of-life cancer care in the Medicare program.
J Geriatr Oncol 2016 Mar;7(2):116-25. doi: 10.1016/j.jgo.2015.11.007.
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Keywords: Cancer, Care Management, Elderly, Medicare, Palliative Care, Outcomes, Patient-Centered Outcomes Research, Practice Patterns