Palliative medicine
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Palliative medicine · Apr 2019
Hospital palliative care consult improves value-based purchasing outcomes in a propensity score-matched cohort.
Hospital-based palliative care consultation is consistently associated with reduced hospitalization costs and more importantly with improved patient quality of life. As healthcare systems move toward value-based purchasing rather than fee-for-service models, understanding how palliative care consultation is associated with value-based purchasing metrics can provide evidence for expanded health system support for a greater palliative care presence. ⋯ Through value-based purchasing, hospitals have 3% of their Medicare reimbursements at risk based on readmission rates. By clarifying prognosis and patient goals, palliative care consultation reduces readmission rates. Hospital systems may want to invest in larger palliative care programs as part of their efforts to reduce hospital readmissions.
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Palliative medicine · Apr 2019
What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review and narrative synthesis.
The number of older people living and dying with frailty is rising, but our understanding of their end-of-life care needs is limited. ⋯ People with frailty have varied physical and psychosocial needs at the end of life that may benefit from palliative care. Frailty services should be tailored to patient and family needs and preferences at the end of life.
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Paramedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic's role in the care of these patients. ⋯ Paramedics have a significant role in caring for patients receiving palliative care. These results should inform the design of integrated systems of care that involve ambulance services in the planning and delivery of community-based palliative care.
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Palliative medicine · Apr 2019
Appointment utilization as a trigger for palliative care introduction: A retrospective cohort study.
Chronic kidney disease palliative care guidelines would benefit from more diverse and objectively defined health status measures. ⋯ Our model could justify the creation of a novel palliative care introduction trigger, as patients with medium demand for care may benefit from additional palliative care evaluation. The trigger could facilitate the uniformization of conservative treatment preparations. It could prompt messages to a managing physician when a patient crosses the threshold between low and medium appointment utilization. It may also aid in system-level policy development. Furthermore, our results highlight the benefit of significant appointment utilization among high-risk patients.