Literature Review

‘Think like a reviewer’: How hospices can use communication, documentation to boost quality McKnights Home Care; by Adam Healy; 9/24/24 Regulators are tightening their scrutiny of the hospice industry, so providers must prioritize the documentation and communication practices that help them obtain higher quality scores. That’s according to hospice industry experts who spoke during an educational session at the National Hospice and Palliative Care Organization’s annual meeting in Denver. “They’re looking closely at the hospice industry,” Angela Huff, senior managing consultant at Forvis Mazars, said last week during the conference. “They have increasing concerns about fraud, waste and abuse in this space. … Don’t think this is going to stop.” ... A key part of hospice quality assurance is communication, Gallarneau said. Providers should support open, friendly channels of communication. This helps staff and clients feel comfortable raising concerns, making quality issues easier to tackle quickly and effectively. Also, prioritizing accuracy in documentation will help providers stay ready for any surveys or audits, Gallarneau noted. Hospices should ensure patient consent and election of benefit forms are properly filled out, signed and dated, and staff should all be trained to do so accordingly. 

That message from your doctor? It may have been drafted by A.I. DNYUZ; 9/24/24 Every day, patients send hundreds of thousands of messages to their doctors through MyChart, a communications platform that is nearly ubiquitous in U.S. hospitals. They describe their pain and divulge their symptoms — the texture of their rashes, the color of their stool — trusting the doctor on the other end to advise them. But increasingly, the responses to those messages are not written by the doctor — at least, not entirely. About 15,000 doctors and assistants at more than 150 health systems are using a new artificial intelligence feature in MyChart to draft replies to such messages. Many patients receiving those replies have no idea that they were written with the help of artificial intelligence. In interviews, officials at several health systems using MyChart’s tool acknowledged that they do not disclose that the messages contain A.I.-generated content. The trend troubles some experts who worry that doctors may not be vigilant enough to catch potentially dangerous errors in medically significant messages drafted by A.I. 

Man accused of choking terminally ill wife accepts plea deal KSL.com; by Pat Reavy; 9/27/24 A man who prosecutors say attempted to end his terminally ill wife's life by choking her has accepted a plea deal. DeWayne McCulla, 46, pleaded guilty on Thursday in 5th District Court to an amended charge of attempted manslaughter, a third-degree felony. The charge comes with a domestic violence sentencing enhancement. Arenda Lee McCulla, 47, died on Dec. 21, 2021, following her battle with breast cancer. The night before, however, as a small group of family members were by her side in La Verkin, DeWayne McCulla "choked the victim in an attempt to kill her to ease her suffering while they were with her during her terminal cancer and being on hospice," according to charging documents. Other family members pulled McCulla off of his wife.Editor's note: Crucial information that is not reported in this article: Where was the hospice team in managing this patient's pain? In educating and supporting the caregiver (the husband?) and family about contacting the hospice? In making required visits when the patient is actively dying? In assessing the caregiver's ability to provide care, especially any history or risks of domestic violence, neglect, or abuse? What safety-in-the-home protocols were used by this hospice, especially when hospice team members followed up? Aware of not-knowing these many factors, I do not ask these with judgment but rather to raise awareness of core, preventive measures for other hospice patients.

[Ghana] A qualitative study on the experiences of family caregivers of children with End Stage Kidney Disease (ESKD)BioPsychoSocial Medicine; Edward Appiah Boateng, Mabel Baaba Bisiw, Rosemary Agyapomah, Isaac Enyemadze, Joana Kyei-Dompim, Samuel Peprah Kumi, Dorothy Serwaa Boakye; 8/24Family caregivers, mostly parents, are greatly involved in the care of their children with end stage kidney disease (ESKD) globally. Yet, the experiences of these caregivers and the demands placed on them by the caregiving role have not been explored or documented in Ghana. The majority of the family caregivers experienced anxiety, fear, uncertainty, and hopelessness in response to the children's diagnosis and care ... [and] ... the thought of the possibility of the children dying was deeply traumatizing for our participants. Most participants reported bodily pains and physical ailments because of lifting and caring for the children. Financial constraint was also a key issue for all the family caregivers. All the family caregivers had their psychological well-being compromised as a result of the challenges they encountered physically, socially, and spiritually.

Alzheimer dementia among individuals with down syndromeJAMA Network Open; Eric Rubenstein, PhD; Salina Tewolde, ScM; Amy Michals, MPH; Jennifer Weuve, ScD; Juan Fortea, MD; Matthew P. Fox, ScD; Marcia Pescador Jimenez, PhD; Ashley Scott, MPH; Yorghos Tripodis, PhD; Brian G. Skotko, MD; 9/24In this cohort study of  ... adults with Down syndrome enrolled in Medicaid or Medicare between 2011 to 2019, 23.3% of adults had Alzheimer dementia diagnoses, and the mean age of death was 59.2 years. These findings suggest that Alzheimer dementia is almost universal among people with Down syndrome, and administrative claims data may offer valuable insights into improving care for this diverse population.

Well-being outcomes of health care workers after a 5-hour continuing education intervention-The WELL-B randomized clinical trialJAMA Network Open; J. Bryan Sexton, PhD; Kathryn C. Adair, PhD; 9/24To test the effectiveness of Well-Being Essentials for Learning Life-Balance (WELL-B), a web-based continuing education program [was developed] to deliver ... interventions to improve 4 dimensions of HCW [health care workers] well-being (ie, emotional exhaustion, emotional thriving, emotional recovery, and work-life integration). [The] ... sessions improved short-term HCW emotional exhaustion, emotional thriving, emotional recovery, and work-life integration. Health care worker impressions of WELL-B were positive. These findings suggest that WELL-B is a beneficial intervention. 

Role of hospital connectedness in brain metastasis outcomesJAMA Network Open; by Lilin Tong, Ruchit V Patel, Ayal A Aizer, Amar Dhand, Wenya Linda Bi; 9/23/24Is hospital connectedness associated with clinical outcomes of patients with brain metastases? In this cohort study of 4679 patients with brain metastases in Massachusetts, increased connectedness of a hospital, defined as the weighted sum of ties to other care facilities, was associated with improved inpatient mortality. Hospital connectedness operated independently from hospital volume in its association with inpatient mortality and length of stay. These findings suggest that relationships between hospitals are associated with changes in patient outcomes in the interdisciplinary care of patients with brain metastases, likely owing to specialized and interdisciplinary care required in the disease management.

Utilization of inpatient palliative care services in cardiac arrest complicating acute pulmonary embolismResuscitation Plus; by Aryan Mehta, Mridul Bansal, Chirag Mehta, Ashwin A Pillai, Salman Allana, Jacob C Jentzer, Corey E Ventetuolo, J Dawn Abbott, Saraschandra Vallabhajosyula; 9/24The role of palliative care services in patients with cardiac arrest complicating acute pulmonary embolism has been infrequently studied. Palliative care services are used in only 16.8 % of admissions with cardiac arrest complicating pulmonary embolism with significant differences in the populations, suggestive of selective consultation.

End-of-life emergency department use and healthcare expenditures among older adults: A nationally representative studyJournal of the American Geriatrics Society; by Cameron J Gettel, Courtney Kitchen, Craig Rothenberg, Yuxiao Song, Susan N Hastings, Maura Kennedy, Kei Ouchi, Adrian D Haimovich, Ula Hwang, Arjun K Venkatesh; 9/24Emergency department (ED) visits at end-of-life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end-of-life ED use, total healthcare spending, and out-of-pocket spending in a nationally representative sample. One in three older adults visit the ED in the last month of life, and approximately one in two utilize ED services in the last half-year of life, with evidence of associated considerable total and out-of-pocket spending.

Screening familial risk for hereditary breast and ovarian cancerJAMA Network; by Daniel Kiser, Gai Elhanan, Alexandre Bolze, Iva Neveux, Karen A Schlauch, William J Metcalf, Elizabeth T Cirulli, Catherine McCarthy, Leslie A Greenberg, Savanna Grime, Jamie M Schnell Blitstein, William Plauth, Joseph J Grzymski; 9/25/24In a large health system, how many ungenotyped patients meet family history genetic testing criteria for hereditary breast and ovarian cancer? In this cross-sectional analysis, 2.9% of patients had no evidence of prior genetic testing but had electronic health records indicating they met family history criteria. These criteria were associated with significantly increased prevalence of genetic risk variants among 38 003 genotyped patients. These findings suggest that substantial gaps exist in identifying and testing patients meeting family history criteria for hereditary breast and ovarian cancer, and other methods may be needed to close these gaps.

The crisp air of September is a reminder to embrace change like the trees embrace new colors. 

Featured Hospice Fund Raisers - compiled by Hospice & Palliative Care TodayCompiled from numerous hospice press releases; by Joy Berger, editor; 9/26/24Editor's note: As hospice and palliative care organizations wrap up summer fundraisers and move into autumn events, we have been compiling sample fundraisers, looking for themes, community engagement, success, and creativity. Typically, we post outcomes--after an event--versus promoting it prior to the event. The purpose is this compilation is to explore the scope of current hospice fundraising in the US. Of note, hospice fundraising throughout the United Kingdom, Australia, New Zealand, and other countries tend to bring in larger amounts, due more extreme need. Enjoy! We welcome your thoughts on this post.