Literature Review

Suffering revisited: Tenets of intensive caring Psychiatric Times; by Harvey Max Chochinov, MD, PhD, FRCPC Patients approaching death experience many losses, including losing a sense of self. This is perhaps one of the most substantive existential challenges dying patients face, as they find the essence of who they are—along with who they were or who they want to be—under assault. This notion of disintegration or fractured sense of personhood often lies at the heart of human suffering, which Eric Cassell, MD, MACP, defined as a person’s severe distress at a threat to their personal integrity. Although suffering can often lead to feelings of hopelessness and therapeutic nihilism for patients and health care professionals, it is important for those of us who care for the dying to understand the nature of suffering and how to be most responsive and therapeutically effective. [This author's Tenets of Intensive Caring include the following:]

Competency standards for quality are needed now more than everModern Healthcare; by Stephanie Mercado; 9/11/24Stephanie Mercado is CEO of the National Association for Healthcare Quality. Healthcare quality is foundational to achieving the overarching goals of every care provider: improving population health, enhancing patient experiences, controlling costs, and more. Yet we are not where we need to be – and sustainably achieving quality and safety goals continues to be just outside of our reach. Why? New research from the National Association for Healthcare Quality reveals that people working in healthcare define quality very differently from one another. They use a range of terms like compliance, utilization management, safety, equity, population health, value. When stakeholders see quality differently and see each effort to advance quality as separate and distinct, it’s no wonder we are not further along in this quest for quality.Publisher's note: This article discusses concerns including care, cost, the workforce cliff, and how quality is achieved.

Updated Care Compare for Hospice ReleasedCMS website; 8/28/24Publisher's note: See link above to access updated Care Compare for Hospice publicly reported quality measures.

CMS rule will align hospitals with age-friendly care for older adultsBecker's Clinical Leadership; by Ashleigh Hollowell; 8/2/24Starting in 2025, a new CMS measure will require public reporting on a hospital's capability to provide age-appropriate care for older adults, the agency announced Aug. 1. The measure is included as part of its FY2025 Inpatient Prospective Payment Systems final rule. Hospitals that participate in Medicare's Hospital Inpatient Quality Reporting Program must begin to report on how they meet each element across five areas, the John A. Hartford Foundation explained via a news release shared with Becker's:

HIMSSCast: Improving patient safety and employee retention with best incident reporting practicesHealthcare IT News; by Andrea Fox; 7/26/24 By modernizing systems and improving leadership and culture to embrace reporting, healthcare organizations can better address the top 10 patient safety concerns for 2024, says Heidi Raines, founder and CEO of Performance Health Partners. Ultimately improving the quality of care healthcare systems deliver and preventing harm requires a degree of self-reflection. Along with digital transformation, putting an easy-to-use incident reporting system in place can help healthcare organizations address today's chief patient safety concerns, including medication errors, care delays, workplace violence and preventing patient falls, said Raines.

Empowering ‘deeply undervalued’ caregivers would improve ‘lifeline for older adults’ McKnights Senior Living; by Kimberly Bonvissuto; 6/28/24 Direct care workers and family caregivers remain “deeply undervalued” and often overlooked despite calls for investment in the care economy, according to the authors of a new report. “These caregivers provide a lifeline for older adults, people with disabilities, and people living with chronic conditions,” PHI and the National Alliance for Caregiving said in an issue brief released Wednesday. “Empowering them in their roles will help to ensure high quality, responsive care to meet the needs and preferences of millions of Americans now and in the future.” The organizations called on providers, Congress, the Department of Labor, the Centers for Medicare & Medicaid Services, the federal Health Resources and Services Administration, states, managed care plans and advocates to invest in the “essential partnership” between direct care workers and family caregivers. The new brief includes insights from a variety of stakeholders ...  The result is a list of recommendations that prioritize improvements to direct care jobs.Editor's Note: Our sponsor, Composing Life Out of Loss, equips hospice and palliative care organizations with caregiver education and support video libraries to strengthen relationships between the direct care professional and the family caregiver, with timely information for the entire family. Contents are written to CMS CoPs, CAHPS, and contemporary grief research; English and Spanish.

'I don't ever trust Epic to be correct': Nurses raise more AI concerns Becker's Health IT; by Giles Bruce; 6/14/24 Nurses continue to voice concerns about artificial intelligence and its integration into EHRs, saying the technology is ineffective and interferes with patient care. Nurses from health systems around the country spoke to National Nurses United, their largest labor union, for a June 5 story about issues with such programs as automated nurse handoffs, patient classification systems and sepsis alerts. Multiple nurses cited problems with EHR-based programs from Epic and Oracle Health that use algorithms to determine patient acuity and nurse staffing levels. "I don't ever trust Epic to be correct," Craig Cedotal, RN, a pediatric oncology nurse at Kaiser Permanente Oakland (Calif.) Medical Center, told the nurses' union. "It's never a reflection of what we need, but more a snapshot of what we've done." ... Hundreds of nurses protested AI at Kaiser Permanente San Francisco Medical Center in April.

ASCO updates Guidelines on Palliative Care Hematology Adviosor; by Jen Smith; 5/30/24 The American Society of Clinical Oncology (ASCO) has released an update to its guidelines on palliative care for cancer patients. The guidelines and related information were published in the Journal of Clinical Oncology and JCO Oncology Practice. To develop updated recommendations for integrating palliative care into cancer care, an expert panel reviewed randomized controlled trials, systematic reviews, and meta-analyses published during 2015-2023. Based on their findings, the experts recommend that patients with advanced cancer be referred to specialized interdisciplinary palliative care teams soon after diagnosis, while the patients are still receiving active cancer treatment.

Compliance Strategies for Forthcoming Hospice HOPE ToolHospice News; by Holly Vossel; 5/16/24Hospices will have a learning curve when it comes to implementing the Hospice Outcomes and Patient Evaluation Tool (HOPE) tool. The U.S. Centers for Medicare & Medicaid Services (CMS) is currently developing quality measures that will be included in the HOPE tool, which will replace the current Hospice Item Set (HIS). After years of development, the agency in its recent hospice proposed rule indicated that the HOPE tool’s implementation would begin in 2025.Notable Mentions: Jennifer Kennedy, CHAP; Kimberly Skehan, CHAP.

End-of-life doulas’ growing value proposition in hospice Hospice News; by Holly Vossel; 5/14/24 Hospices and other health care providers are increasingly recognizing the value proposition of end-of-life doulas. Organizations are taking varied routes to leverage doula’s skills to improve quality. End-of-life doulas support patients and their families in a number of broad and diverse ways, according to Erin Collins, program director of The Peaceful Presence Project. Collins is also a certified hospice and palliative care nurse and end-of-life doula. She serves as vice-chair of the National Hospice and Palliative Care Organization’s (NHPCO) End-of-Life Doula Advisory Council. Editor's Note: Caution. What training, professional experience, credentials, referrals, and other qualifications does the individual, end-of-life care doula bring? Not bring? What gaps in your services (for which a doula might be called) indicate that your organization needs to "step up" your community education, caregiver/family resources, psychosocial support, and volunteer presence?

Star ratings of Leapfrog's 25 straight-'A' and 'F' hospitals Becker's Hospital Review; by Mackenzie Bean; updated 5/3/24 A comparison of data from CMS and The Leapfrog Group suggests that a hospital's strong performance in one national quality rating system does not necessarily mean it will be a top performer in another. Leapfrog updated its spring safety grades May 1, recognizing 15 hospitals that have received an "A" grade in every consecutive update since 2012. Of these hospitals, only eight received a five-star rating from CMS. Similar discrepancies are seen across Leapfrog's "F" hospitals. While two did receive one star — the lowest possible rating — another five received two stars, and one hospital earned four stars. [Click on the title's link for the list.]

Breaking the silence: The mounting need for trauma-informed hospice care Hospice News; by Holly Vossel; 5/3/24Traumatized and abused hospice patients and providers often experience an array of lingering physical, emotional and psychological effects that can fall into a silent abyss of unmet needs. ... Many seniors have experienced some form of trauma or abuse in their lifetime. ... More data has become available in recent years around the prevalence of different types of abuse and trauma. Roughly 10% of seniors 65 and older nationwide are victims of some type of abuse each year, the U.S. Department of Justice (DOJ) reported. Caregiver neglect represents 5.1% of these cases, with psychological and physical abuse impacting 4.6% and 1.6% of seniors, respectively. ...Editor's Note: This article highights interviews with Dr. Ashwin Kotwal, assistant professor at the University California San Francisco; Carole Fisher, president, National Partnership for Healthcare and Hospice Innovation (NPHI); Dr. Cameron Muir, chief innovation officer, NPHI; Andrea Devoti, executive vice president at the National Association for Home Care & Hospice (NAHC); Lindsey Owen, executive director of Disability Rights Vermont.