Literature Review

YoloCares: Overregulated California skips key regulations Our Community Now (OCN); by Craig Dresang, Special to The Enterprise; 8/17/24 California is the most heavily regulated state in the country. According to the Mercatus Center at George Mason University, the Golden State has 420,434 regulatory restrictions which is more than double the national average. ... So, it seems ironic that certain critically important sectors in California that impact the well-being, health and quality of life for millions of seniors are grossly unchecked and mis-regulated. My husband, who has owned and operated salons for nearly 30 years, pointed out that California’s Board of Barbering and Cosmetology (BBC) appears to have more rigorous rules and regulations for nail technicians than it does for board-and-care (B&C) owners or privately owned hospice companies. ... [Click on the title's link to continue reading.]

Mortuaries get a modern-day makeover The Hustle; by Sara Friedman; 8/20/24 When window shopping in a city, it’s often an aesthetic storefront that captures your attention and pulls you inside. But what if the handcrafted vase that caught your eye was actually an urn for human remains? That’s the business model for the crop of trendy, modernized mortuaries popping up around the world, per The New York Times. ... Pretty enough to be spas or nightclubs, these new mortuaries bring some levity to customers looking for something different. In a Co-Op Funeralcare study of 4k people in the UK, 68% said they see funerals as celebrations of life, not sad occasions. [Examples given] ... These new mortuary models are tapping into a lucrative industry: The average funeral costs ~$6.6k in London, while the median cost of a US funeral is $8.3k.

It’s a poor sort of memory that only works backwards… ~Lewis Carroll, Through the Looking-Glass, And What Alice Found There

[Ireland] Does a palliative medicine service reduce hospital length of stay and costs in adults with a life-limiting illness?-a difference-in-differences evaluation of service expansion in IrelandAnnals of Palliative Medicine; by Soraya Matthews, Eimir Hurley, Bridget M Johnston, Pauline Kane, Karen Ryan, Eoin Tiernan, Charles Normand, Peter May; 7/24People approaching end of life account disproportionately for health care costs, and the majority of these costs accrue in hospitals. The economic evidence base to improve value of care to this population is thin. Our primary analytic sample included 4,314 observations, of whom 608 (14%) received timely palliative care. We estimated that the intervention reduced LOS [length of stay] by nearly two days, with an estimated associated saving per admission of €1,820.

[Netherlands] Potentially inappropriate end of life care and healthcare costs in the last 30 days of life in regions providing integrated palliative care in the Netherlands: A registration-based studyInternational Journal of Integrated Care; by Chantal F R Pereira , Anne-Floor Q Dijxhoorn, Berdine Koekoek, Monique van den Broek, Karin van der Steen, Marijanne Enge, Marjon van Rijn, Judith M Meijers, Jeroen Hasselaar, Agnes van der Heide, Bregje D Onwuteaka-Philipsen, Marieke H J van den Beuken-van Everdingen, Yvette M van der Linden, Manon S Boddaert, Patrick P T Jeurissen, Matthias A W Merkx, Natasja J H Raijmakers; 7/24This study aimed to assess the effect of integrated palliative care (IPC) on potentially inappropriate end- of-life care and healthcare-costs in the last 30 days of life in the Netherlands. In regions providing IPC deceased adults (n = 37,468) received significantly less potentially inappropriate end-of-life care post-implementation compared to pre-implementation. Mean hospital costs significantly decreased for deceased adults who received IPC ... while mean costs increased for general practitioner services. This study shows less potentially inappropriate end-of-life care and a shift in healthcare costs from hospital to general practitioner and home care with IPC.

Transitional palliative care for family caregivers: Outcomes from a randomized controlled trialJournal of Pain and Symptom Management; by Joan M Griffin, Jay N Mandrekar, Catherine E Vanderboom, William S Harmsen, Brystana G Kaufman, Ellen M Wild, Ann Marie Dose, Cory Ingram, Erin E Taylor, Carole J Stiles, Allison M Gustavson, Diane E Holland; 8/24Patients receiving inpatient palliative care often face physical and psychological uncertainties during transitions out of the hospital. Family caregivers often take on responsibilities to ensure patient safety, quality of care, and extend palliative care principles, but often without support or training, potentially compromising their health and well-being. This study tested an eight-week intervention using video visits between palliative care nurse interventionists and caregivers to assess changes in caregiver outcomes and patient quality of life. Addressing rural caregivers' needs during transitions in care can enhance caregiver outcomes and improve patient quality of life.

Is it early enough? The authentic meaning of the pediatric palliative approach between early and late referral in pediatric oncology: a case studyFrontiers in Oncology; by Anna Santini, Irene Avagnina, Maria C Affinita, Anna Zanin, Franca Benini; 7/24The literature widely supports the benefits of early integration of palliative care into pediatric oncological care; however, many barriers to its successful integration remain. Integrating palliative care as early as possible in the oncology pathway is critical, but other criteria are relevant to positive results. This paper aims to contribute to the early/late referral dualism in pediatric palliative care (PPC) and highlight the importance of a collaborative approach between oncologists and palliative care teams. This study investigates the impact of early versus late referral to PPC, intersecting it with the synergy work between services and the related outcomes.

Palliative rehabilitation in patients with cancer: definitions, structures, processes and outcomesCurrent Oncology Reports; by Jegy M. Tennison, Jack B. Fu, David Hui; 8/24This review examines the literature on palliative rehabilitation for patients with advanced cancer, focusing on definitions, structures, processes, and outcomes. Palliative cancer rehabilitation emphasizes a collaborative approach that integrates palliative care with rehabilitation interventions, aiming to enhance quality of life and address diverse patient needs. The outcomes of palliative cancer rehabilitation varied widely by goals, settings, and interventions. Studies in hospice settings generally reported improved symptom control; inpatient rehabilitation had mixed functional outcomes; and outpatient palliative rehabilitation may contribute to enhanced functional and symptom outcomes, especially among patients with higher baseline function.

A protocol for the inclusion of minoritized persons in Alzheimer Disease research from the ADNI3 Diversity TaskforceJAMA Open Network; by Ozioma C Okonkwo, Monica Rivera Mindt, Miriam T Ashford, Catherine Conti, Joe Strong, Rema Raman, Michael C Donohue, Rachel L Nosheny, Derek Flenniken, Melanie J Miller, Adam Diaz, Annabelle M Soto, Beau M Ances, Maryam R Beigi, P Murali Doraiswamy, Ranjan Duara, Martin R Farlow, Hillel T Grossman, Jacobo E Mintzer, Christopher Reist, Emily J Rogalski, Marwan N Sabbagh, Stephen Salloway, Lon S Schneider, Raj C Shah, Ronald C Petersen, Paul S Aisen, Michael W Weiner, Alzheimer’s Disease Neuroimaging Initiative; 8/24Black or African American (hereinafter, Black) and Hispanic or Latino/a/x (hereinafter, Latinx) adults are disproportionally affected by Alzheimer disease, but most research studies do not enroll adequate numbers of both of these populations. The Alzheimer's Disease Neuroimaging Initiative-3 (ADNI3) launched a diversity taskforce to pilot a multipronged effort to increase the study inclusion of Black and Latinx older adults. In this cross-sectional study of pilot inclusion efforts, a culturally informed, community-engaged approach increased the inclusion of Black and Latinx participants in an Alzheimer disease cohort study.

Fraudulent hospices reportedly target homeless people, methadone patients to pad census Hospice News; by Jim Parker; 8/23/24 Fraudulent hospices in California reportedly have been targeting homeless people and methadone patients, promising them a steady supply of opioids in exchange for enrolling in hospice. Three hospice leaders came forward to Hospice News to report these practices. According to their reports, unscrupulous providers have canvassed both homeless encampments and methadone clinics seeking to sign up patients who are not terminally ill. In many cases, the sources said, these operators offer patients free access to board-and-care facilities and a daily supply of morphine. Another frequent practice among these hospices is to offer patients cash or other items in addition to drugs, they said. “This conduct raises serious fraud concerns on kickbacks or gifts to beneficiaries who do not appear to qualify for hospice,” Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), told Hospice News. “More importantly, this conduct is predatory, taking advantage of individuals in addiction. Jail time is not enough punishment for the harm that such conduct creates.”Editor's Note: This is abhorrable. Click on the title's link to read more. While John Oliver's "Last Week Tonight" episode on 8/18/24 gained criticism from many hospice leaders, these fraudulent unethical behaviors (and others') lay the groundwork for such dire distrust from the public. These organizations' behaviors must be stopped. These persons and organizations must be held accountable. 

Does a patient’s ability to pay for health care make their life worth saving?JAMA Open Network; by Zara Cooper, MD, MSc; 7/24In this well-executed study using data from the American College of Surgeons Trauma Quality Improvement Program (TQIP), Hoit et al demonstrated that the timing of withdrawal of life-sustaining treatment (WLST) in critically injured adults between ages 18 and 64 years was statistically associated with the type of insurance they carried. Specifically, the authors showed that even after accounting for patient and hospital characteristics, individuals without insurance were approximately 50% more likely to undergo WLST earlier than others who were insured (eg, private insurance or Medicaid). ... it is incumbent upon individual clinicians and health systems to closely and uncomfortably examine how bias either creeps or marches into the life-and-death decisions we make for everyone under our care.

Protecting patients and society in an era of private equity provider ownership: Challenges and opportunities for policyHealth Affairs; by Christopher Cai, Zirui Song; 5/24Private equity (PE) acquisitions in health care delivery nearly tripled from 2010 to 2020. Despite concerns around clinical and economic implications, policy responses have remained limited. We discuss the US policy landscape around PE ownership, using policies in the European Union for comparison. We present four domains in which policy can be strengthened.

Executive Personnel Changes - 8/16/24