Abstract:
BACKGROUND:Rehospitalizations are prevalent and associated with decreased quality of life. Although hospice has been advocated to reduce rehospitalizations, it is not known how area-level hospice utilization patterns affect rehospitalization risk. OBJECTIVES:The study objective was to examine the association between hospice enrollment, local hospice utilization patterns, and 30-day rehospitalization in Medicare patients. METHODS:With a retrospective cohort design, 1,997,506 hospitalizations were assessed between 2005 and 2009 from a 5% national sample of Medicare beneficiaries. Local hospice utilization was defined using tertiles representing the percentage of all deaths occurring in hospice within each Hospital Service Area (HSA). Cox proportional hazard models were used to assess the relationship between 30-day rehospitalization, hospice enrollment, and local hospice utilization, adjusting for patient sociodemographics, medical history, and hospital characteristics. RESULTS:Rates of patients dying in hospice were 27% in the lowest hospice utilization tertile, 41% in the middle tertile, and 53% in the highest tertile. Patients enrolled in hospice had lower rates of 30-day rehospitalization than those not enrolled (2.2% versus 18.8%; adjusted hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.118-0.131). Patients residing in areas of low hospice utilization were at greater rehospitalization risk than those residing in areas of high utilization (19.1% versus 17.5%; HR, 1.05; 95% CI, 1.04-1.06), which persisted beyond that accounted for by individual hospice enrollment. CONCLUSIONS:Area-level hospice utilization is inversely proportional to rehospitalization rates. This relationship is not fully explained by direct hospice enrollment, and may reflect a spillover effect of the benefits of hospice extending to nonenrollees.
journal_name
J Palliat Medjournal_title
Journal of palliative medicineauthors
Holden TR,Smith MA,Bartels CM,Campbell TC,Yu M,Kind AJdoi
10.1089/jpm.2014.0395subject
Has Abstractpub_date
2015-07-01 00:00:00pages
601-12issue
7eissn
1096-6218issn
1557-7740journal_volume
18pub_type
杂志文章abstract:BACKGROUND:Employment-related issues have been largely overlooked in cancer patients needing palliative care. These issues may become more relevant as cancer evolves into more of a chronic illness and palliative care is provided independent of stage or prognosis. OBJECTIVE:To characterize the employment situations of ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2016.0478
更新日期:2017-07-01 00:00:00
abstract::Symptom control for hospice patients frequently involves the use of pharmacologic agents for control of pain, dyspnea, and anxiety. Other troubling symptoms that will often require pharmacologic agents include nausea, vomiting, constipation, and delirium. While the Medicare requirement for hospice is a prognosis of si...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0095
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:Although the role of volunteers is at the heart of hospice care, little is known about hospice volunteer training and volunteer activity. METHOD:A survey was used to assess current training programs for hospice volunteers. Hospices were invited to participate in the study from a link on the website for the ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2009.0240
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:There are no evidence-based recommendations for statin continuation or discontinuation near the end of life. However, some expert opinion recommends continuing statins prescribed for secondary versus primary prevention of cardiovascular disease. OBJECTIVES:Our aim was to explore statin prescribing patterns ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2012.0158
更新日期:2013-04-01 00:00:00
abstract:INTRODUCTION:Many proponents of hospice care believe that this service is underutilized. OBJECTIVE:To determine physicians' perceptions of hospice utilization and of their own hospice referral pattern; their perceived and actual knowledge of appropriate hospice referral diagnoses; and perceived barriers to hospice ref...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/1096621041349518
更新日期:2004-06-01 00:00:00
abstract::An advance directive, a description of one's future preferences for medical treatment, must be easily available to care providers to ensure that one's treatment preferences are honored. The transition of our health care system to an electronic medical record complicated the availability of a patient's written advance ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/109662103322144880
更新日期:2003-06-01 00:00:00
abstract:BACKGROUND:The evidence base to support palliative care clinical practice is inadequate and opportunities to improve the palliative care evidence base remain despite the field's rapid growth. OBJECTIVE:To examine current NIH funding of palliative medicine research, changes since our 2013 report, and trends since our 2...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2017.0287
更新日期:2018-02-01 00:00:00
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journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2005.8.291
更新日期:2005-04-01 00:00:00
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journal_title:Journal of palliative medicine
pub_type: 杂志文章,多中心研究
doi:10.1089/jpm.2011.0301
更新日期:2012-02-01 00:00:00
abstract::Palliating the whole person requires that medicine attend more fully to the phenomenon of existential suffering. The role of social factors, in particular, is often overlooked in attempts to understand why end-of-life suffering does not always respond to physiologic, psychological, and spiritual interventions. Using q...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/109662104322737223
更新日期:2004-02-01 00:00:00
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journal_title:Journal of palliative medicine
pub_type: 杂志文章,多中心研究
doi:10.1089/jpm.2012.0467
更新日期:2013-10-01 00:00:00
abstract::As new accreditation standards for health professions education increasingly require end-of-life (EOL) curriculum and performance-based assessment, health professions educators struggle to shift through the educational literature to find core principles, practical strategies, emerging trends, and on-line resources to ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/109662101750290263
更新日期:2001-07-01 00:00:00
abstract:BACKGROUND:Living at home is an important factor for maintaining high quality of life among patients. Many studies have discussed parameters associated with place of death, but no studies have yet clarified which factors influence the length of stay at home during the end of life. OBJECTIVE:The aim of this study was t...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2016.0455
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Cancer pain continues to be undertreated, despite the availability of evidence-based guidelines. The Australian National Pain Strategy identified establishment of systems and guidelines to adequately manage cancer pain as a high priority. OBJECTIVES:This study aimed to identify barriers and facilitators to ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0245
更新日期:2013-11-01 00:00:00
abstract:: Background: Futile or potentially inappropriate care (futile/PIC) for dying inpatients leads to negative outcomes for patients and clinicians. In the setting of rising end-of-life health care costs and increasing physician burnout, it is important to understand the causes ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0385
更新日期:2019-09-01 00:00:00
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journal_title:Journal of palliative medicine
pub_type: 杂志文章,多中心研究
doi:10.1089/jpm.2012.0173
更新日期:2013-01-01 00:00:00
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journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2020.0622
更新日期:2020-12-22 00:00:00
abstract:BACKGROUND:Response bias in end of life research is important though not well understood. OBJECTIVES:To compare consenting advanced cancer patient participants and refusers in observational end of life research. We hypothesized that, compared with refusers, consenters would: 1) have a stronger belief in personal gain ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2005.8.115
更新日期:2005-02-01 00:00:00
abstract:CONTEXT:Research shows an increased symptom burden in young adult (YA) cancer patients compared with their older adult counterpart. OBJECTIVES:The purpose of this study was to identify differences in clinical characteristics and related outcomes between YA and older adult cancer patients admitted for cancer-related pa...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0212
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Persons with cystic fibrosis (CF) experience high morbidity and mortality, yet little is known about their palliative care needs and how clinicians may address these needs. OBJECTIVES:(1) To identify palliative care and advance care planning needs of patients with CF and their families; and (2) to identify ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2017.0259
更新日期:2018-04-01 00:00:00
abstract:: Background: Providers often use birth plans to document parents' wishes for their fetus with a life-limiting condition. Objective: The objective of the study was to (1) discover important components of a birth plan for parents ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0596
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:The provision of complementary therapy in palliative care is rare in Canadian hospitals. An Ontario hospital's palliative care unit developed a complementary therapy pilot project within the interdisciplinary team to explore potential benefits. Massage, aromatherapy, Reiki, and Therapeutic Touch™ were provid...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0295
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:There is a dearth of international research on hospice physiotherapy. This study aims to profile hospice physiotherapy in an Irish setting in order to inform practice internationally. DESIGN:The study design consisted of a retrospective chart audit over 6 months. SETTING:The study took place at a specialist...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2011.0480
更新日期:2012-07-01 00:00:00
abstract:BACKGROUND:In the United States, the American Indian and Alaska Native (AI/AN) population is aging and the leading causes of death for those 55 and older are chronic diseases such as cancer, heart disease, and the complications of diabetes. Since 1955, the federally directed Indian Health Service, along with Tribal gov...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2004.7.830
更新日期:2004-12-01 00:00:00
abstract::Many physicians and patients do not discuss care at the end of life and most practicing physicians have had little formal education concerning end-of-life discussions. To address this deficiency, our internal medicine residency faculty participated in the National End of Life Residency Education Project and implemente...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/10966210260499131
更新日期:2002-12-01 00:00:00
abstract:BACKGROUND:Surrogates and clinicians often make treatment decisions for decisionally incapacitated patients with limited knowledge of their preferences. This study examined patients' life-sustaining treatment preferences to facilitate advance care planning discussions and surrogate decision making. METHODS:We intervie...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2000.3.37
更新日期:2000-04-01 00:00:00
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journal_title:Journal of palliative medicine
pub_type: 杂志文章,评审
doi:10.1089/jpm.2010.0326
更新日期:2011-02-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:In 2014, Nova Scotia released a provincial palliative care strategy and implementation working groups were established. The Capacity Building and Practice Change Working Group, comprised of health professionals, public advisors, academics, educators, and a volunteer supervisor, was asked to se...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2017.0655
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:Pain, dyspnea, and depression are highly troubling near the end of life. OBJECTIVE:To characterize factors associated with clinically significant pain and the presence of dyspnea and depression during the last year of life in a nationally representative sample. DESIGN:Retrospective cohort study. SETTING:H...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2015.0391
更新日期:2016-10-01 00:00:00
abstract::In this review we discuss the history of Hospice and Palliative Medicine (HPM) physician education in the United States over the last 20 years, as there has been dramatic growth in our specialty during this time. A Medline literature search was completed and we surveyed leaders in the field of HPM education regarding ...
journal_title:Journal of palliative medicine
pub_type: 历史文章,杂志文章,评审
doi:10.1089/jpm.2012.0436
更新日期:2013-03-01 00:00:00