The Impact of a Palliative Care Program in a Rural Appalachian Community Hospital: A Quality Improvement Process

American Journal of Hospice and Palliative Medicine

Volumn 30, Issue 4, 2013, Pages 380-387

  Armstrong, Bernita ^a   Jenigiri, Bharat ^a   Hutson, Sadie P ^b   Wachs, Peter M ^c   Lambe, Camille Eckerd ^d  

^a Pikeville Medical Center   (United States)

^b UNIVERSITY OF TENNESSEE   (United States)

^c APPALACHIAN STATE UNIVERSITY   (United States)

^d DUKE UNIVERSITY   (United States)

Author keywords

cost effectiveness; end of life care; palliative care; palliative care consultation team; quality of life; symptom burden

Indexed keywords

ADULT; AGED; ANALGESIA; ARTICLE; COMMUNICATION DISORDER; COMMUNITY HOSPITAL; COST CONTROL; COST-EFFECTIVENESS; ECONOMICS; EVALUATION STUDY; FEMALE; HEALTH PERSONNEL ATTITUDE; HOSPITAL PATIENT; HUMAN; HUMAN RELATION; MALE; METHODOLOGY; MIDDLE AGED; ORGANIZATION AND MANAGEMENT; PALLIATIVE CARE CONSULTATION TEAM; PALLIATIVE THERAPY; PATIENT SATISFACTION; QUALITY OF LIFE; RURAL HEALTH CARE; SICKNESS IMPACT PROFILE; STANDARD; STATISTICS; SYMPTOM BURDEN; TERMINAL CARE; TOTAL QUALITY MANAGEMENT; UNITED STATES; VERY ELDERLY;

COST-EFFECTIVENESS; END-OF-LIFE CARE; PALLIATIVE CARE; PALLIATIVE CARE CONSULTATION TEAM; QUALITY OF LIFE; SYMPTOM BURDEN;

ADULT; AGED; AGED, 80 AND OVER; APPALACHIAN REGION; ATTITUDE OF HEALTH PERSONNEL; COMMUNICATION DISORDERS; COST CONTROL; FEMALE; HOSPITALS, COMMUNITY; HUMANS; INPATIENTS; MALE; MIDDLE AGED; PAIN MANAGEMENT; PALLIATIVE CARE; PATIENT SATISFACTION; PROFESSIONAL-FAMILY RELATIONS; PROFESSIONAL-PATIENT RELATIONS; QUALITY IMPROVEMENT; RURAL HEALTH SERVICES; SICKNESS IMPACT PROFILE;

EID: 84878663725     PISSN: 10499091     EISSN: None     Source Type: Journal    
DOI: 10.1177/1049909112458720     Document Type: Article

References (40)

1. Grudzen C.At the end of life, sometimes less is more.Arch Intern Med. 2011;171 (13): 1201-1201.
2. Baker R,Wu AW,Teno JM, et al.Family satisfaction with end-of-life care in seriously ill hospitalized adults.J Am Geriatr Soc. 2000;48 (5 suppl): S61-S69.
3. Teno JM,Clarridge BR,Casey V, et al.Family perspectives on end-of-life care at the last place of care.JAMA. 2004;291 (1): 88-93.
4. Rice EM,Betcher DK.Evidence base for developing a palliative care service.Medsurg Nurs. 2007;16 (3): 143-148.
5. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators.JAMA. 1995;274 (20): 1591-1598.
6. Morrison RS,Dietrich J,Ladwig S, et al.Palliative care consultation teams cut hospital costs for Medicaid beneficiaries.Health Aff (Millwood). 2011;30 (3): 454-463.
7. Weissman DE,Meier DE,Spragens LH.Center to Advance Palliative Care palliative care consultation service metrics: consensus recommendations.J Palliat Med. 2008;11 (10): 1294-1298.
8. Weigl G.Palliative care in the management of heart failure.Wien Med Wochenschr. 2008;158 (23-24): 739-744.
9. Casarett D,Johnson M,Smith D,Richardson D.The optimal delivery of palliative care: a national comparison of the outcomes of consultation teams vs inpatient units.Arch Intern Med. 2011;171 (7): 649-655.
10. Brumley R,Enguidanos S,Jamison P, et al.Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care.J Am Geriatr Soc. 2007;55 (7): 993-1000.
11. Wright AA,Zhang B,Ray A, et al.Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment.JAMA. 2008;300 (14): 1665-1673.
12. Lorenz KA,Lynn J,Dy SM, et al.Evidence for improving palliative care at the end of life: a systematic review.Ann Intern Med. 2008;148 (2): 147-159.
13. Morrison RS,Penrod JD,Cassel JB, et al.Cost savings associated with US hospital palliative care consultation programs.Arch Intern Med. 2008;168 (16): 1783-1790.
14. Angus DC,Barnato AE,Linde-Zwirble WT, et al.Use of intensive care at the end of life in the United States: an epidemiologic study.Crit Care Med. 2004;32 (3): 638-643.
15. MullinE.Access to palliative care leeps ahead in hospitals. Dorland Health. July 2011. http://www.dorlandhealth.com/adult_and_senior/trends/Access-to-Palliative-Care-in-Hospitals-Leaps-Ahead_1855.html. Accessed December 13, 2011.
16. MorrisonRSMeierDE. America's Care of Serious Illness: A State-by-State Report Card. 2011. http://www.capc.org/reportcard/pdf/state-by-state-report-card-pdf. Accessed October 15, 2011.
17. The Dartmouth Institute for Health Policy and Clinical Practice. The Dartmouth Atlas of Health Care. 2011. www.dartmouthatlas.org. Accessed October 12, 2011.
18. Edens PS HC,Gilden KM.Developing and financing a palliative care program.Am J Hosp Palliat Care. 2008;25 (5): 379-384.
19. Hutson SP,Dorgan KA,Phillips AN,Behringer B.The mountains hold things in: the use of community research review work groups to address cancer disparities in Appalachia.Oncol Nurs Forum. 2007;34 (6): 1133-1139.
20. Van Vorst RF,Crane LA,Barton PL,Kutner JS,Kallail KJ,Westfall JM.Barriers to quality care for dying patients in rural communities.J Rural Health. 2006;22 (3): 248-253.
21. Dorgan KA,Hutson SP,Gerding G,Duvall KL.Culturally tailored cancer communication, education, and research: the highways and back roads of Appalachia.Prev Chronic Dis. 2009;6 (2): A68.
22. Bigbee JL,Lind B.Methodological challenges in rural and frontier nursing research.Appl Nurs Res. 2007;20 (2): 104-106.
23. Robinson CA,Pesut B,Bottorff JL,Mowry A,Broughton S,Fyles G.Rural palliative care: a comprehensive review [published online February 13, 2009].J Palliat Med. 2009;:.
24. Kelley ML,Habjan S,Aegard J.Building capacity to provide palliative care in rural and remote communities: does education make a difference?.J Palliat Care. 2004;20 (4): 308-315.
25. Schrader SL,Nelson ML,Eidsness LM.Palliative care teams on the prairie: composition, perceived challenges & opportunities.S D Med. 2007;60 (4): 147 151-149 153.
26. Cassel JB,Webb-Wright J,Holmes J,Lyckholm L,Smith TJ.Clinical and financial impact of a palliative care program at a small rural hospital.J Palliat Med. 2010;13 (11): 1339-1343.
27. Weissman DE,Meier DE.Operational features for hospital palliative care programs: consensus recommendations.J Palliat Med. 2008;11 (9): 1189-1194.
28. Stiel S,Pastrana T,Balzer C,Elsner F,Ostgathe C,Radbruch L.Outcome assessment instruments in palliative and hospice care-a review of the literature [published online March 13, 2012].Support Care Cancer. 2012;:.
29. Herr K,Bjoro K,Decker S.Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review.J Pain Symptom Manage. 2006;31 (2): 170-192.
30. Higginson IJ,Finlay IG,Goodwin DM, et al.Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers?.J Pain Symptom Manage. 2003;25 (2): 150-168.
31. Tools for Palliative Care Programs. Center to Advance Palliative Care. www.capc.org/tools-for-palliative-care-programs/. Accessed August 20, 2010.
32. Cohen SR,Mount BM,Strobel MG,Bui F.The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability.Palliat Med. 1995;9 (3): 207-219.
33. Kamal AH,Maguire JM,Wheeler JL,Currow DC,Abernethy AP.Dyspnea review for the palliative care professional: assessment, burdens, and etiologies.J Palliat Med. 2011;14 (10): 1167-1172.
34. Heyland DK,Dodek P,Rocker G, et al.What matters most in end-of-life care: perceptions of seriously ill patients and their family members.CMAJ. 2006;174 (5): 627-633.
35. Gelfman LP,Meier DE,Morrison RS.Does palliative care improve quality? A survey of bereaved family members.J Pain Symptom Manage. 2008;36 (1): 22-28.
36. Jones JM,McPherson CJ,Zimmermann C,Rodin G,Le LW,Cohen SR.Assessing agreement between terminally ill cancer patients' reports of their quality of life and family caregiver and palliative care physician proxy ratings.J Pain Symptom Manage. 2011;42 (3): 354-365.
37. Desbiens NA,Mueller-Rizner N,Connors AF,Wenger NS,Lynn J.The symptom burden of seriously ill hospitalized patients. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcome and Risks of Treatment.J Pain Symptom Manage. 1999;17 (4): 248-255.
38. O'Mahony S,Blank AE,Zallman L,Selwyn PA.The benefits of a hospital-based inpatient palliative care consultation service: preliminary outcome data.J Palliat Med. 2005;8 (5): 1033-1039.
39. Smith TJ,Cassel JB.Cost and non-clinical outcomes of palliative care.J Pain Symptom Manage. 2009;38 (1): 32-44.
40. Birks T,Krikos D,McGowan C,Stone P.Is there a need for weekend face-to-face inpatient assessments by hospital specialist palliative care services? Evaluation of an out-of-hours service.Palliat Med. 2011;25 (3): 278-283.