Transcript End of Life Readmission and Chronic Illness that Could

Readmission and Chronic illness that could
benefit from end of life discussions.
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Palliative care is an Interdisciplinary specialty
that aims to relieve suffering and improve
quality of life for patients with advanced
illness, and their families. It is provided
simultaneously with all other appropriate
medical treatment.
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Pain and Symptom Control
Goal setting
Prognostication
Psycho-Spiritual support
Integration at start of a life threatening
illness—not just in the final days of life.
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Hospice is both a philosophy, and a health
care reimbursement system
◦ Restrictions on eligibility (< 6 months prognosis)
◦ Restrictions on treatments (palliative intent and
only treatments that are financially feasible).
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Palliative Care has no restrictions on
eligibility or use of treatments.
Hospice is a subset of Palliative Care, for
patients who meet the hospice eligibility
requirements.
http://www.cdc.gov/nchs/fastats/copd.htm
 Number of noninstitutionalized adults who have ever
been diagnosed with emphysema: 4.9 million
 Percent of noninstitutionalized adults who have ever
been diagnosed with emphysema: 2.2%
 Source: Summary Health Statistics for U.S. Adults:
National Health Interview Survey, 2009, tables 3, 4
Nursing home care
 Number of residents with chronic obstructive
pulmonary disease: 190,000
 Percent of residents with chronic obstructive
pulmonary disease: 13%
 Source: 2004 National Nursing Home Survey,
Residents, table 33B
http://www.cdc.gov/dhdsp/data_statistics/fact_shee
ts/fs_heart_failure.htm
 Around 5.8 million people in the United States have
heart failure. About 670,000 people are diagnosed
with it each year.1
 About one in five people who have heart failure die
within one year from diagnosis.1
 Heart failure was a contributing cause of 282,754
deaths in 2006.1
 In 2010, heart failure will cost the United States
$39.2 billion.1 This total includes the cost of health
care services, medications, and lost productivity.
 The most common causes of heart failure are
coronary artery disease, high blood pressure, and
diabetes.
http://www.careimprovementplus.com/newsroom/CCM.asp
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 More than 133 million Americans live with chronic
illnesses. 1
 Chronic diseases such as diabetes and heart failure are the
leading cause of death and disability in the U.S.,accounting
for 70 percent of all deaths.1, 2
 Nearly 80 percent of Medicare beneficiaries have at least
one of the following chronic conditions: stroke, diabetes,
emphysema, heart disease, hypertension, arthritis,
osteoporosis, Parkinson's disease or urinary incontinence.2
 People with chronic conditions are the most frequent users
of health care in the U.S. They account for 81 percent of
hospital admissions; 91 percent of all prescriptions filled;
and 76 percent of all physician visits4
 About one-fourth of people with chronic conditions have
one more daily activity limitations5
http://tdi.dartmouth.edu/documents/publications/2009Feb
_JPalliatMed_Berke.pdf
Excerpt from full article
“Our analyses show that a cohort definition based on a union
of Part A and Part B Medicare claims data, using a 180-day
window prior to death, includes the largest number of
patients while still overlapping with hospice patients with a
principal diagnosis of cancer. The 180-day window
corresponds to the 6-month eligibility criteria established
by Medicare,10 and is consistent with data showing that
the majority of patients enroll in hospice in the 180 days
prior to death.”
“Using a cohort definition based on joined Medicare Part A
and B data and a primary or secondary diagnosis of
cancer, with a more severe secondary diagnosis, appears
to yields the most appropriate nationally representative
sample of cancer deaths for age older than 65.”
http://www.ncqa.org/Portals/0/PublicComment/HEDIS2009/Medicare_Me
mo_and_Workup_PDF.pdf
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The vast majority of older adults take medication to
address at least three or more chronic conditions. Many
have multiple prescribing physicians and use more than
one pharmacy.
Furthermore, approximately two out of five seniors report
that they are not taking medication because of the cost,
side-effects, perceived lack of effectiveness or belief that
they do not need the medication (National Survey of
Seniors and Prescription Drugs 2003).
Additionally, for those elderly patients who appear to be
noncompliant with drug regimens, their regimens tend to
be more complex, making it difficult for them to manage
medications.
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Readmission Registry allows opportunity to:
◦ Have conversation with attending provider as to
belief of life expectancy.
◦ Ask the Question “ do you believe that this patient
will decline over the next year up to and possibly
include death?”
◦ Ask the patient “ Do you believe that your health is
as good as it was last year or even 6 months ago?”
◦ Ask the Provider “ Do you think a palliative consult
might encourage the patient to think about limiting
treatment ?”