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Showing posts from October, 2016

Aligning Quality and Cost Savings Through Home Based Palliative Care

by:  Timothy Poore ( @TimCPoore ) More than 90% of non-institutionalized people over the age of 65 in the United States receive health insurance through Medicare.(1) Of the money Medicare spends on individuals, it spends nearly one quarter in the final year of one’s life, and the majority of that money is spent on hospitalizations.2,3  With much talk during this election season about entitlement reform and the looming bankruptcy of Medicare, a study recently published in The Journal of Palliative Medicine is of particular interest, offering insight on how Medicare could save money by focusing on end-of-life care at home. Cost Savings of Home Based Palliative Care Dana Lustbader and colleagues conducted a retrospective study , comparing costs of care and resource utilization during the final year of life for patients who were enrolled in a home based palliative care program, and those who received usual care.  All patients included in this study received their care from Pr

Can your Emergency Physician find your Advance Directive?

by:  Ryan Van Wert, MD Providing high quality emergency care to individuals with serious, life-limiting illness starts with an understanding of their treatment goals and care preferences above all else.  Speaking as a critical care physician, this is absolutely essential information to have at the time of an emergency. It helps me to formulate a plan to provide the best possible care for an individual in the context of their wishes. It also helps to frame care recommendations when speaking to families, and to support them through the difficult task of speaking for a loved one who cannot be heard. So I was very interested to see two recent publications in the Journal of Palliative Medicine relating to accessibility of advance care planning (ACP) documents in the emergency department (ED). The first study from Angelo Volandes’ group looked at 104 elderly individuals presenting to the ED at an academic medical center. Participants were asked about whether they had completed any

Keep Your Hands to Yourself

This week’s GeriPal podcast is all about mechanical ventilation and dementia.  In particular, we discuss a new article in JAMA IM which concluded that the use of mechanical ventilation for nursing home residents with advanced dementia doubled from 2000 to 2013 without a substantial improvement in survival.    We also talk about a recent JAGS article about integrating palliative care in the nursing home . by: Eric Widera ( @ewidera ), Alex Smith ( @alexsmithmd ), and Ken Covinsky ( @geri_doc ) ------   Note: GeriPal Podcasts can be found on: iTunes  Google Play Music Soundcloud Stitcher Transcript of the podcast: Ken: Welcome to Geripal Podcast number three. Alex, do you want to start us with a song? I was thinking, in honor of Bob Dylan's receiving the noble prize in literature, how about some musical literature Alex? Alex: Oh, Bob Dylan. I don't think I have any Dylan on hand. But what I do have is “Keep your hands to yourself” by the The Georgi

GeriPal Podcast #2: Breath Becomes Air or Nothing Becomes Something

In our second GeriPal Podcast, we discuss Professor Thomas Laqueur's  review of Paul Kalanithi's book " When Breath Becomes Air ."  Professor Laqueur's review, titled " Nothing Becomes Something ," was published in the London Review of Books .  Eric Widera reviewed the book for GeriPal here .  (See links at the bottom if the picture/media player below doesn't show up.) by: Eric Widera ( @ewidera ), Alex Smith ( @alexsmithmd ), and Ken Covinsky ( @geri_doc ) produced by: Sean Lang-Brown ( ) ------ Note: GeriPal Podcasts can be found on: iTunes  Google Play Music Soundcloud Transcript of the Podcast: Eric: This is GeriPal Podcast. This is Eric Widera. Alex: This is Alex Smith. Ken: Ken Covinski. Alex: Part Two is a new segment that we are tentatively calling Tell Us What You Really Think. In this segment, we're going to talk about reviews of the book When Breath Becomes

GeriPal Podcast Episode 1: Bed Alarms

Welcome to GeriPal's innagural podcast episode titled "Bed Alarms".   This is the first in a series of podcasts on all things geriatrics, hospice, and palliative care.   So check it out at the link below ( or click here ): With each of these podcasts we will also publish a GeriPal post with citations of the articles we mentioned during the discussion.   For this episode, we discussed the following articles: Barker Anna L, Morello Renata T, Wolfe Rory, Brand Caroline A, Haines Terry P, Hill Keith D et al. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial BMJ 2016; 352 :h6781 Shorr RI, Chandler AM, Mion LC, Waters TM, Liu M, Daniels MJ, et al. Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients: A Cluster Randomized Trial. Ann Intern Med. 2012;157:692-699 . Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-Associated Disability“She Was Probably Able to Ambulate,

Palliative Care Consultations in Nursing Homes: It Can (and Should) Be Done

by: Eric Widera ( @ewidera ) One out of every four people living in the United States will die in a nursing home.  To say that access to palliative care is lacking for these individuals would be an understatement. What palliative care is delivered is too often limited to those who are eligible for and elected hospice care. A study published in JAGS this week gives us some of the best evidence so far that palliative care can be delivered in this setting, and is associated with less hospitalizations and burdensome transitions. A Study of Palliative Care in the Nursing Home The study author s looked at data from two palliative care provider organizations that were subsidiaries of hospice agencies in order to identify nursing home palliative care consultations in North Carolina and Rhode Island.  Between the study years of 2005 to 2010, these two organizations were the only providers of palliative care consultations in the two counties in North Carolina and the six in Rhode Is