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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 22 of 22 Research Studies DisplayedLeBlanc 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, Bull JH, Wolf SP
Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S.
The researchers sought to understand the prevalence and predictors of burnout among hospice and palliative care clinicians using a discipline-wide survey. They found that most burnout stemmed from emotional exhaustion, and that factors associated with higher rates of burnout include working in smaller organizations, working longer hours, being younger than 50 years, and working weekends. They concluded that strategies at the discipline-wide and individual levels are needed to sustain the delivery of responsive, available, high-quality palliative care for all patients with serious illness.
AHRQ-funded; HS022989.
Citation: Kamal AH, Bull JH, Wolf SP .
Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S.
J Pain Symptom Manage 2016 Apr;51(4):690-6. doi: 10.1016/j.jpainsymman.2015.10.020.
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Keywords: Provider: Health Personnel, Palliative Care, Stress, Workforce
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
Dy SM, Herr K, Bernacki RE
Methodological research priorities in palliative care and hospice quality measurement.
The authors describe three key priorities: 1) defining the population of interest for palliative care quality indicators, 2) developing methods to measure quality from different data sources, and 3) conducting research to advance the development of patient/family-reported indicators. They apply these concepts to the key quality domain of advance care planning and address relevance to implementation of indicators in improving care in order to facilitate improved quality measurement across all populations with serious illness and care for patients and families.
AHRQ-funded; HS023681.
Citation: Dy SM, Herr K, Bernacki RE .
Methodological research priorities in palliative care and hospice quality measurement.
J Pain Symptom Manage 2016 Feb;51(2):155-62. doi: 10.1016/j.jpainsymman.2015.10.019.
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Keywords: Research Methodologies, Palliative Care, Quality Measures, Quality Indicators (QIs), Quality of Care
Dinan MA, Li Y, Zhang Y
Resource use in the last year of life among patients who died with versus of prostate cancer.
The researchers conducted a retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data of men with prostate cancer. Patients who died of prostate cancer rather than from other causes had more hospice and outpatient use, less inpatient and ICU use, and lower overall costs. Efforts to shift care toward outpatient settings might provide more efficient and judicious care for patients during the end of life.
AHRQ-funded; HS022189.
Citation: Dinan MA, Li Y, Zhang Y .
Resource use in the last year of life among patients who died with versus of prostate cancer.
Clin Genitourin Cancer 2016 Feb;14(1):28-37.e2. doi: 10.1016/j.clgc.2015.07.006.
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Keywords: Cancer, Cancer: Prostate Cancer, Healthcare Costs, Healthcare Utilization, Men's Health, Mortality, Palliative Care, Patient-Centered Outcomes Research
Thienprayoon R, Marks E, Funes M
Perceptions of the pediatric hospice experience among English- and Spanish-speaking families.
The objective of this study was to explore parental perspectives of the hospice experience in children with cancer, and to explore how race/ethnicity impacts this experience. Both English and Spanish speakers described the importance of honest, direct communication by medical providers, and anxieties surrounding the expectation of the moment of death. English-speaking families were more likely to return to the hospital because of unsatisfactory symptom management.
AHRQ-funded; HS022418.
Citation: Thienprayoon R, Marks E, Funes M .
Perceptions of the pediatric hospice experience among English- and Spanish-speaking families.
J Palliat Med 2016 Jan;19(1):30-41. doi: 10.1089/jpm.2015.0137.
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Keywords: Children/Adolescents, Palliative Care, Long-Term Care, Racial and Ethnic Minorities, Cancer
Rhodes RL, Nazir F, Lopez S
Use and predictors of end-of-life care among HIV patients in a safety net health system.
The authors examined completion of advance directives, use of palliative care, and enrollment in hospice among HIV patients who receive care at an urban safety net hospital. They found that the rates of advance directive completion, palliative care use, and hospice use were low. They recommended that advances should be made in identifying those patients earlier in their disease trajectories.
AHRQ-funded; HS022418.
Citation: Rhodes RL, Nazir F, Lopez S .
Use and predictors of end-of-life care among HIV patients in a safety net health system.
J Pain Symptom Manage 2016 Jan;51(1):120-5. doi: 10.1016/j.jpainsymman.2015.08.010.
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Keywords: Human Immunodeficiency Virus (HIV), Palliative Care, Urban Health
