Journal of palliative medicine
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Background: Community-dwelling adults with serious illness benefit from conversations about their goals for care. Objective: We undertook a project to increase the number of serious illness conversations occurring in an accountable care organization (ACO) using a script delivered telephonically by nurse care managers. Design: Working with nurses previously trained in the basics of geriatric assessment and goals-of-care conversations, we used a quality improvement framework to modify the Ariadne Laboratories Serious Illness Conversation Guide to a six-question script. Subjects: Our target population was a subset of patients enrolled in a program within the ACO for patients who are high health care utilizers. Measures: After testing and modifying the script, we imbedded it into the initial nursing assessment in the electronic medical record. The electronic medical record prompts the nurses to ask the questions every three months to track changes in goals of care over time. Results: We have increased documentation of goals-of-care conversations from 33% of patients in the subpopulation during the first month of this project to 86% at the end of the first year. Nurse care managers' report that clinical outcomes are improved by these conversations. Conclusions: This project demonstrates a unique way to modify the Serious Illness Conversation Guide for use by nurses as part of a health care team. This project can be adapted by other health care organizations trying to increase goals-of-care conversations in their patient population.
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Background: Advance care planning (ACP) often occurs too late in the disease course of those who are affected by brain tumors. Furthermore, the perspectives of brain tumor stakeholders on ACP are not well described. We reviewed a social media tweet chat to understand barriers to ACP experienced by brain tumor stakeholders. ⋯ Three key themes emerged regarding brain tumor stakeholder perspectives about ACP: (1) attitudinal barriers prevent discussions of death; (2) need to ensure one's voice is heard; and (3) Goldilock's approach to timing-fearing ACP is too early or too late. Conclusions: Various stakeholders, including people with brain tumors, shared perspectives on ACP through a tweet chat and highlighted important challenges and opportunities. Twitter is a new avenue for patients, clinicians, and advocates to engage with each other to better understand each other's perspectives related to ACP.
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Background/Aims: Patients with end-stage liver disease (ESLD) have a high risk for readmission. We studied the role of palliative care consultation (PCC) in ESLD-related readmissions with a focus on health care resource utilization in the United States. Methods: We performed a retrospective longitudinal analysis on patients surviving hospitalizations with ESLD from January 2010 to September 2014 utilizing the Nationwide Readmissions Database with a 90-day follow-up after discharge. ⋯ US $69,035, p < 0.01). Conclusion: Inpatient utilization of PCC for ESLD is increasing annually, yet still remains low in the United States. More importantly, PCC was associated with a decline in readmission rates resulting in a lower burden on health care resource utilization and improvement in cost savings during subsequent readmissions.