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The Impact Of Two Triggered Palliative Care Consultation Approaches On Consult Implementation In Oncology.

L. DiMartino, B. Weiner, L. Hanson, M. Weinberger, S. Birken, K. Reeder-Hayes, J. Trogdon
Published 2019 · Medicine

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INTRODUCTION Studies show palliative care delivered concurrently with cancer treatment improves outcomes, yet palliative care integration with inpatient oncology is underused. A promising approach to improve integration is a triggered palliative care consultation (TPCC). This study evaluated the impact of two TPCC approaches on consistency and quality of consult implementation, operationalized as uptake and timeliness, on solid tumor medical and gynecologic oncology services at an academic hospital. METHODS The study timeframe was 2010-2016. TPCC in gynecologic oncology began in 2014 and was supported by a single strategy (written guideline); TPCC in medical oncology began in 2015 and was supported by multiple strategies (e.g. training, chart review). Palliative care consult information was chart abstracted and linked to hospital encounter data. We compared the effect of a single strategy vs. usual care, and multiple strategies vs. a single strategy on implementation. Difference-in-differences modified Poisson regression models evaluated whether implementation differed after TPCC; we estimated adjusted relative risk (aRR), controlling for patient demographic and clinical characteristics. RESULTS Overall, 8.8% of medical oncology and 11.0% of gynecologic oncology inpatient encounters involved palliative care consultation. In regression analyses, TPCC supported by a single strategy in gynecologic oncology was associated with greater uptake vs. usual care (aRR: 1.45, p < .05), and TPCC supported by multiple strategies in medical oncology was associated with greater uptake vs. a single strategy (aRR: 2.34, p < .001). CONCLUSION Across two inpatient oncology services, TPCC supported by multiple strategies had the greatest impact on uptake. How strategies affect sustained use of palliative care consults remains to be investigated.
This paper references
Methods for evaluating changes in health care policy: the difference-in-differences approach.
J. Dimick (2014)
Integrating Palliative and Oncology Care for Patients with Advanced Cancer: A Quality Improvement Intervention.
L. Hanson (2017)
Predictors of access to palliative care services among patients who died at a Comprehensive Cancer Center.
N. Fadul (2007)
A Quantitative Study of Triggered Palliative Care Consultation for Hospitalized Patients With Advanced Cancer.
Gabrielle B. Rocque (2015)
The Costs of Waiting: Implications of the Timing of Palliative Care Consultation among a Cohort of Decedents at a Comprehensive Cancer Center.
Colin Scibetta (2016)
Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial.
Marie Bakitas (2009)
Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update.
B. Ferrell (2017)
Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data
H. Quan (2005)
Late referral to palliative care consultation service: length of stay and in-hospital mortality outcomes.
J. Humphreys (2014)
The Current State of Palliative Care for Patients Cared for at Leading US Cancer Centers: The 2015 NCCN Palliative Care Survey.
B. Calton (2016)
Measuring what matters: top-ranked quality indicators for hospice and palliative care from the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association.
S. Dy (2015)
End-of-life care for hospitalized patients with lung cancer: utilization of a palliative care service.
B. Reville (2010)
The quality of supportive cancer care in the veterans affairs health system and targets for improvement.
A. Walling (2013)
The Challenge of Innovation Implementation
Katherine J. Klein (1996)
Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial
C. Zimmermann (2014)
Choosing and Using Screening Criteria for Palliative Care Consultation in the ICU: A Report From the Improving Palliative Care in the ICU (IPAL-ICU) Advisory Board*
J. Nelson (2013)
Palliative care consultation teams cut hospital costs for Medicaid beneficiaries.
R. Morrison (2011)
Guiding inpatient quality improvement: a systematic review of Lean and Six Sigma.
Justin M. Glasgow (2010)
Predictors of palliative care consultation on an inpatient gynecologic oncology service: are we following ASCO recommendations?
C. Lefkowits (2014)
A modified poisson regression approach to prospective studies with binary data.
G. Zou (2004)
Developing a service model that integrates palliative care throughout cancer care: the time is now.
A. Partridge (2014)
Changing Provider Behavior: An Overview of Systematic Reviews of Interventions
J. Grimshaw (2001)
Standardized criteria for required palliative care consultation on the solid tumor oncology service.
J. Paris (2013)
Emergency department-triggered palliative care in advanced cancer: proof of concept.
Emmett A. Kistler (2015)
Clinical findings of a palliative care consultation team at a comprehensive cancer center.
N. Dhillon (2008)
The quality of supportive care among inpatients dying with advanced cancer
A. Walling (2012)
Palliative care needs of patients with cancer living in the community.
A. Kamal (2011)
Prospective Cohort Study of Hospital Palliative Care Teams for Inpatients With Advanced Cancer: Earlier Consultation Is Associated With Larger Cost-Saving Effect.
P. May (2015)
Use of inpatient palliative care services in patients with metastatic incurable head and neck cancer
Carolyn L. Mulvey (2016)
Early palliative care for patients with metastatic non-small-cell lung cancer.
J. Temel (2010)

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