Journal of pain and symptom management
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J Pain Symptom Manage · Jul 2009
Optimizing decision making and resource allocation in palliative care.
Optimizing resource allocation in end-of-life care is one of the most difficult issues currently being addressed within the U. K. National Health Service. ⋯ Arguably, the value placed on improving quantity and quality of life is dependent on the context in which they are derived. In such circumstances, we can either adjust cost-effectiveness thresholds to ensure that end-of-life interventions have a less stringent cost-effectiveness hurdle to overcome or we can derive an entirely new evaluative framework that better captures the true value of interventions focusing primarily on care rather than cure. Irrespective of the approach taken, optimizing resource allocation in palliative care is crucial in ensuring that overall therapeutic objectives both for individual patients and for this patient group as a whole are achieved to the greatest degree possible.
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J Pain Symptom Manage · Jul 2009
How advocates use health economic data and projections: the Irish experience.
Approximately 30,000 people die in Ireland each year. Currently over 6000 people access specialist palliative care services annually, a figure that is projected to rise to 12,500 by 2016. In 2006, the Irish Hospice Foundation entered a joint advocacy alliance with the Irish Cancer Society and the Irish Association for Palliative Care. ⋯ New services can only be developed if there is strong evidence to illustrate that they are cost-effective in delivering patient care. Having reviewed the international evidence, the joint advocacy group has used this economic evidence to strengthen the case that the development of palliative care services can actually save money in health budgets. The campaign mounted by the joint advocacy group was greatly facilitated by the existence of good data and an agreed evidence-based policy on what constitutes a comprehensive service.
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The remarkable growth of palliative care in the United States in the last 25 years has been fueled by the expansion of Medicare to include a hospice benefit. Medicare provides health insurance for qualified elderly individuals and Medicaid covers the poor. Hospice benefits are the same for both Medicare and Medicaid. ⋯ U. S. hospice care is predominantly care delivered in the place the patient calls home (95.6%). Although the hospice benefit has provided palliative care for more patients and families than any other country, the requirements for use have been found to be self-limiting.
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J Pain Symptom Manage · Jul 2009
ReviewQuality indicators for palliative care: a systematic review.
Research has demonstrated a greater understanding of the needs of terminally ill patients and their families, but it also has been found that the palliative care is not optimal. Because of a lack of quality indicators in palliative care, the quality of the care is often not assessed. The aim of this systematic review was to give an overview of published quality indicators for palliative care in all patient groups and settings, to determine whether these quality indicators cover all domains of palliative care, to describe the different types of quality indicators, and to determine the methodological characteristics of the quality indicators. ⋯ The methodological characteristics of the quality indicators varied considerably. We conclude that a substantial number of quality indicators for palliative care are available, but most have not been described in detail. More detailed methodological specifications are needed to accurately monitor the quality of palliative care.