Articles: palliative-care.
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Randomized Controlled Trial
Performance of Patient-Reported Outcome Measures in a Large Pragmatic Trial of Home-Based Palliative Care (HomePal): Methodological and Practical Considerations for Embedded Patient-Centered Design.
Background: The research enterprise has embraced patient centeredness in embedded efficient pragmatic trials, but limited data exist on using patient-reported outcomes (PROs) collected as part of usual clinical care for research. Objectives: We sought to assess the performance of different assessment methods for obtaining PROs in a pragmatic cluster randomized trial (HomePal study) designed to compare two models of home-based palliative care (HBPC). Design: Descriptive analytics, comparative trends, and psychometric performance of PROs collected in the HomePal study; measures included Edmonton Symptom Assessment System (ESAS), PROMIS-10, and others administered at baseline, 1, and 6 months. ⋯ These differences persisted with follow-up ESAS measures. Conclusions: We identified significant variability in PRO responses between different surveyors and whether proxy interaction was needed suggesting complex issues around PRO measure performance for pragmatic embedded trials. ClinicalTrials.gov Identifier: NCT03694431.
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J Pain Symptom Manage · Apr 2022
Identification of Uncontrolled Symptoms in Cancer Patients Using Natural Language Processing.
For patients with cancer, uncontrolled pain and other symptoms are the leading cause of unplanned hospitalizations. Early access to specialty palliative care (PC) is effective to reduce symptom burden, but more efficient approaches are needed for rapid identification and referral. Information on symptom burden largely exists in free-text notes, limiting its utility as a trigger for best practice alerts or automated referrals. ⋯ This study demonstrated initial feasibility of using NLP to identify hospitalized cancer patients with uncontrolled symptoms. Further model development is needed before these algorithms could be implemented to trigger early access to PC.
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Background: A significant shortage of palliative care (PC) services exists for American Indian and Alaska Native people (AI/ANs) across the United States. Using an implementation science framework, we interviewed key individuals associated with AI/AN-focused PC programs to explore what is needed to develop and sustain such programs. Objectives: To identify facilitators of implementation and barriers to sustainability associated with the development of PC programs designed for AI/ANs across the United States. ⋯ Barriers to program sustainability include a lack of administrative leadership support. Discussion: AI/AN-focused PC programs should be congruent with community needs. PC program developers should focus on sustainability well before initial implementation.
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Annals of family medicine · Apr 2022
Assessing the application of continuity of care indices in the last year of life: a retrospective population-based study.
Context: Most people spend the majority of their last year of life at home or in a home-like setting, receiving outpatient healthcare. Increasing numbers of physicians and teams, including palliative care providers, may become involved in care in addition to a usual provider such as a family physician. Continuity of care (CoC) near the end of life, although considered a marker of quality of care, may be interrupted despite the provision of high-quality care. ⋯ Results were similar for other indices. Conclusions: Decedents experience low continuity of outpatient physician care in the last year of life, especially those with cancer, comorbidities, and frequent physician visits. Modifications to existing indices may be needed to serve as end-of-life care quality indicators.
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Objective: The aim of this study was to evaluate an adult home palliative care (HPC) program for multiple insurance product lines using multiple vendors to determine if the annual costs of health care decreased for those enrolled in HPC. Study Design: Of the 506 members who were referred to and qualified for palliative care in 2019, a retroactive review was done comparing annual health care costs between the 396 members in the enrolled group and the 110 members in the group receiving usual care. Methods: The total health care costs for the calendar year 2019 were compared between the group enrolled in HPC and those who received usual care. ⋯ Conclusions: Adult home-based palliative care delivered by multiple vendors (consisting of multiple insurance product lines) to a population is effective in decreasing total medical costs by 16.7% during a calendar year compared with a control group. The gross savings for those enrolled for 6-12 months (17.9%) were greater than the gross savings for those enrolled for 1-5 months (15.8%). The savings were most prominent for the commercial insurance product, while an increase in cost was seen for the Medicaid product.