November 24th, 2011 by RyanDuBosar in Research
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Sending dementia patients to the hospital could overwhelm the health care system and not offer them any better care at the end of life, researchers noted.
The researchers obtained data on all hospitalizations involving a dementia diagnosis for the 85 years and older group between years 2000 and 2008 from the nationally representative Nationwide Inpatient Sample database, a part of the Agency for Healthcare Research and Quality Healthcare Costs and Utilization Project.
Annual hospitalization data came from the U.S. Census Bureau. They projected the future volume of hospitalizations involving a dementia diagnosis in the 85 years and older group two ways, Read more »
*This blog post was originally published at ACP Internist*
November 9th, 2011 by Lucy Hornstein, M.D. in Opinion
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Cancer is a dreadful disease. Just dreadful. Make no mistake: I have tremendous respect for the awesome doctors who treat patients afflicted with it day after day. Still, paradoxically, I can’t help but notice that some of them have just as hard a time as do other doctors with caring for patients at the end of their lives. I believe a large part of their difficulty stems from the ridiculously dysfunctional either/or approach to palliative care and hospice we’re stuck with in this benighted country.
The problem is that in order to qualify for hospice, patients must not only have a certified life expectancy of less than six months, but they must also not be undergoing any active treatment for their malignancy. When you stop to think about it, though, this is actually quite discriminatory. We don’t require people on hospice with other diagnoses to discontinue their life sustaining medications. Patients with COPD are allowed to continue their bronchodilators; CHF patients don’t have to stop their ACE inhibitors and digoxin. But if a cancer patient wants to qualify for hospice, they have to forgo curative treatments like chemotherapy.
So what if the oncologists call it “palliative” chemo instead? Read more »
*This blog post was originally published at Musings of a Dinosaur*
October 31st, 2011 by RyanDuBosar in Research
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Providing information of imminent death to cancer patients does not increase pain or anxiety, but is associated with improved care and to increase the likelihood of fulfilling the principles of a good death, a Swedish study found.
Informed patients significantly more often had parenteral drugs prescribed as needed, died in his or her preferred place, and had an informed family who were offered bereavement support. There was no difference between informed and uninformed patients in control of pain, anxiety, nausea, and respiratory tract secretions, although there was a difference in management of confusion. Results appeared in the Journal of Clinical Oncology.
Since 2000, there has been an increasing focus on palliative care in Sweden, the study authors wrote. In 2001, the Swedish Government identified breakpoints for Read more »
*This blog post was originally published at ACP Hospitalist*
August 9th, 2011 by Elaine Schattner, M.D. in Opinion, Research
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We’ve reached the second half of our discussion on Bending the Cost Curve in Cancer Care. The authors of the NEJM paper, Drs. T. Smith and B. Hillner, go on to consider how doctors’ behavior influences costs in Changing Attitudes and Practice. Today’s point on the list: “Oncologists need to recognize that the costs of care are driven by what we do and what we do not do.”
In other words (theirs): “The first step is a frank acknowledgment that changes are needed.” A bit AA-ish, but fair enough –
The authors talk about needed, frank discussions between doctors and patients. They emphasize that oncologists/docs drive up costs and provide poorer care by failing to talk with patients about the possibility of death, end-of-life care, and transitions in the focus of care from curative intent to palliation.
They review published findings on the topic: Read more »
*This blog post was originally published at Medical Lessons*
April 16th, 2011 by RyanDuBosar in Research
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Chronically-ill Medicare patients spent fewer days in the hospital and received more hospice care in 2007 than they did in 2003, but their intensity of care increased as well, according to a report by the Dartmouth Atlas Project.
While in the hospital less, patients had many more visits from physicians, particularly specialists, and spent more days in intensive care units, as result of growth in intensive care and specialist capacity, the researchers said.
Intensive interventions can lower a patients’ quality of life and cost more, the researchers noted. About one-fourth of all Medicare spending stems from the last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease, the authors noted. Following patient preferences for end-of-life care may reduce such spending. Read more »
*This blog post was originally published at ACP Hospitalist*
