The Hospice e-News

What the Media Said about End-of-Life Care This Week

Week of May 22, 2006

…a service of Florida Hospices and Palliative Care

 

 

MEDICARE COULD SAVE MONEY AND IMPROVE OUTCOMES FOR PATIENTS WITH CHRONIC ILLNESS

 

A new study by the Center for the Evaluative Clinical Sciences (CECS) at Dartmouth Medical School has found that “lower utilization of acute care hospitals and physician visits could actually lead to better results for patients and prolong the solvency of the Medicare program.”  According to the press release, the widely reported study, “The Care of Patients with Severe Chronic Illness:  An Online Report on the Medicare Program,” calls for

“overhauling how the nation manages chronic illness and proposes that hospitals take leadership in redesigning how they care for the critically ill.”

 

Principal investigator John E. Wennberg, MD, MPH, cites three factors that “drive the differences in cost and quality of care” – “unmanaged supply of resources, limited evidence about what kind of care really contributes to the health and longevity of the chronically ill, and falsely optimistic assumptions about the benefits of more aggressive treatment of people who are severely ill with medical conditions that must be managed but can't be cured.”

 

The study, also called the Atlas report, found that, between 2000 and 2003, Medicare could have saved $40 billion – one third of what it spent on care during that time – if all hospitals used the “high quality/low cost standard” found in the Salt Lake City area.  The report calls the fact that the chronically ill elderly are mostly provided care for their chronic illness by acute care hospitals a “fundamental problem,” one that contributes to both excessive spending and poorer outcomes.  The press release cites the report as saying, “The financial incentives used by Medicare and most other payers encourage the overuse of acute care hospital services and the proliferation of medical specialists.”  The researchers project that Medicare spending on chronic illness could be cut by 30% if hospitals took less intensive approaches and reduced admissions, ICU days and specialist referrals.

 

The problem, however, doesn’t lie just with Medicare, the report says.  Rather, the whole healthcare system is in “disarray over the treatment of chronic illness.”  Evidence-based guidelines are lacking and they would help determine when patients should be hospitalized, admitted to intensive care or referred to specialists, or when tests should be ordered.  Without these guidelines, decisions are driven by the belief on the part of doctors and patients that more services mean better outcomes.  Because of this, utilization of services is driven by availability of services, not by the incidence of illness.

 

Dr. Donald M. Berwick, president and CEO of the Institute for Healthcare Improvement, says, “This report should end the ‘more is better’ myth in health care.  The nation can do a lot to improve the quality and lower the cost of health care once providers, policymakers, payers and the public share an understanding that 'more care' is not by any means always ‘better care,’ and that new technologies and hospital stays can sometime harm more than they help.”

 

Wennberg says, “The majority of acute care hospitals are applying their standard forms of ‘rescue medicine’ to people who are in advanced stages of diseases that can’t be cured.  Patients don’t benefit – they can’t be rescued – and the costs of such care are very high, both in dollars spent and in providing care that the majority of chronically-ill patients might not want, such as admissions to intensive care and being sent to specialist after specialist.”

 

Using the report’s data, investigators will, for the first time, be able to “compare the efficiency of states, regions and their individual hospitals and associated physicians in treating patients with chronic illness.”  The report, online at the Dartmouth Atlas Project website, www.dartmouthatlas.org, also has interactive data tools and links to hospital reports by state.  Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, which funded the Atlas Project, said, “We need information like this to ensure that our health care dollars are spent on high-quality health care that results in better outcomes for patients.”  (Dartmouth Atlas Project Website; The Wall Street Journal, 5/16; USA Today, 5/16; Senior Journal Website, 5/16; The Orlando Sentinel, 5/17)

 

 

NQF ENDORSES PALLIATIVE CARE & HOSPICE QUALITY FRAMEWORK

 

Last week, the National Quality Forum (NQF) endorsed the National Framework and Preferred Practices for Palliative and Hospital Care Quality.  The framework is partially based on the Clinical Guidelines for Quality Palliative Care, which were issued in 2004 by the National Consensus Project. 

 

The framework is a comprehensive structure to be used in evaluating the quality of hospice and palliative care.  It contains 38 preferred practices for delivering high-quality care, and nine research recommendations for improving the measurement and evaluation of hospice and palliative care.

 

Check the NQF website, www.qualityforum.org, where excerpts from the framework are to be posted.  (PR Newswire US, 5/18)

 

 

DOULAS HELP FAMILIES THROUGH THE DYING HOURS

 

“For the Families of the Dying, Coaching as the Hours Wane,” in last Saturday’s New York Times, says, “There is a growing realization that hospice has its limitations.  Doctors, nurses, social workers, clerics and volunteers are rarely there for the final hours, known as active dying, when a family may need their comforts the most.”  In response, some hospices, such as Continuum Hospice Care in New York City, are implementing programs in which volunteers keep vigils at the bedside with the families of the dying.

 

Twenty-nine specially trained doulas, from a Greek word meaning “to serve,” participate in Continuum’s program, which worked with a dozen families in its first year.  Their job is to protect the scene of death, a “sacred space” in the Buddhist tradition, and make it as peaceful as possible for the patient and family.  That may mean sitting and holding the patient’s hand or facilitating a peaceful space for the patient by dealing with family members who may disrupt the scene. 

 

One family of three sisters, meeting with Henry Fersko-Weiss, Continuum’s vice-president for counseling services, a month after their father died to review their experiences with him, had the opportunity to reflect on both the good and the distressing.  Three doulas stayed with the family, in shifts, for two days, until the man passed away.  One of the sisters commented, “It was like we could hear you talking to us.  ‘You’ll see this.  You’ll hear a certain breathing pattern.’  This dying was such a wonderful experience, if death can be that.  And it’s because there was no fear of the unknown.”  (The New York Times, 5/20)

 

 

NURSING SHORTAGE NOTES

 

*  Karen Backus, director of the Nurse Alliance of the Service Employees International Union, says that the choices made by hospitals to address the problem of short staffing “have made working conditions nearly impossible for nurses to provide the highest quality care.”  Backus says that hospitals don’t raise wages to meet staffing needs but, rather make nurses work excessive overtime, rely on contingent staff and hiring bonuses and “simply don’t staff the floors with enough nurses to provide top-notch care for all patients.”  (Chicago Sun Times, 5/13)

 

*  Northern Illinois University and Harper Community College are teaming up to allow students to earn four-year nursing degrees from NIU by taking classes at Harper.  Harper had been pushing for a pilot program which would allow it to offer bachelor’s degrees in nursing and technology.  The state’s four-year universities objected and Harper dropped its plans after the partnership with NIU was formed.  (Chicago Tribune, 5/12)

 

*  New Jersey figures show that more than 40% of its nurses are over age 50, while fewer than 6% are under 30.  Richard Hader, of Meridian Health, adds that a large number of those entering nursing schools are themselves over 30 and will be reaching retirement sooner themselves.  Hader says that the “common wisdom” that nurses are “overworked and underpaid” is no longer true, since RN starting salaries are in the high $40s and can reach as much as $95,000.  (Asbury Park Press, 5/7)

 

 

RESEARCH AND RESOURCE NOTES

 

*  In The Quality of Life, Janet Lembke tells how caring for her mother prompted her to write about the quality of life at the end of life.  The reviewer says that Lembke’s “exquisitely written book” shows that “the actuality of day-to-day caretaking for loved ones with dementia is fraught with trials and barriers.”  One doctor told Lembke, “There’s something to be said for the quality of death.  Few people ever plan for the quality of their death.”  (Townsend Letter for Doctors and Patients, 5/1)

 

*  A new survey by The Partnership for a Drug-Free America reports that abuse of prescription drugs by teenagers has become an “entrenched behavior” that often goes unrecognized by parents.  Twenty percent of teenagers have tried painkillers such as OxyContin or Vicodin and many think they are less dangerous than illegal drugs.  (The Record, 5/16)

 

*  The same health factors that may kill you someday also increase your risk of having to live in a nursing home.  A recent study found that “modifiable lifestyle factors -- smoking, physical inactivity, obesity, high blood pressure, and diabetes, but not total cholesterol -- substantially increased the risk of nursing home placement.”  Middle-age persons were more at risk than those who were elderly, which suggests that earlier prevention is more effective than later, the article says.”  The article is online at www.nlm.nih.gov/medlineplus/news/fullstory_33296.html.  (Medline Plus Website, 5/9)

 

 

PUBLIC POLICY NOTES

 

*  A recently-enacted Colorado law, quietly promoted by Compassion & Choices, will protect “doctors and caregivers from being prosecuted under the manslaughter statute for giving palliative care to the terminally ill.”  One physician who worked for the law’s passage said, “It’s important to emphasize that this is not a physician-assisted suicide law.”  (The Denver Post)

 

*  A recent VA directive, with policies and procedures for managing outpatients and scheduling appointments says that patients needing urgent or emergent hospice or palliative care will not be wait listed, but that the “VHA must offer to provide or purchase needed hospice or palliative care services without delay.”  (US Fed News, 5/8)

 

*  The Florida Attorney General’s Office has funded a pilot program, run by the Community Hospice of Northeast Florida, to “ensure that family and friends of murder victims take advantage of the many victims’ assistance programs in the area.”  The program will provide volunteers to accompany families as they identify bodies, help them file for compensation, provide therapy, offer grief services, and provide special programs for children.  (Florida Times-Union, 4/26)

 

 

OTHER NOTES

 

*  For years, people have been creating web memorials after the death of loved ones, but the ones that are springing up at places like MySpace and Facebook are sites created by the young person themselves before they died and then left in place for others to visit.  Thomas Franz, associate professor of counseling at the University of Buffalo, says  “Teens especially need an outlet.  Teenagers have a harder time grieving than any other age group.”  (USA Today, 5/11)

 

*  The family of Michael Todd, who had obtained a temporary restraining order against the University of Kansas Hospital when it wanted to discontinue Michael’s medical treatment because doctors had declared him brain dead, dropped their opposition to the hospital’s plan after another neurosurgeon agreed with the previous doctors.  (The Kansas City Star, 5/16; KCTV News Website, 5/19)

 

*  An article in Chain Drug Review says that the reluctance of pharmacy chains to fill “aggressive” prescriptions for pain has resulted in pharmacies which specialize in filling pain prescriptions.  Those pharmacies “understand the special needs of [pain] patients and doctors treating them,” and “relationships among physicians, patients and pharmacists in such settings are usually closer, resulting in more responsive individual patient care.”  The irony, the author says, is that “pain management specialty pharmacies are growing into new chain pharmacy entities.”(Chain Drug Review, 5/1)

 

*  The Maine Veterans’ Homes organization has adopted the use of the Resource CareTracker program to record assessment information needed for the federally-required Minimum Data Set.  The staff development coordinator at the home in Augusta said, “Now that CareTracker has simplified the documentation process for our CNAs, our clinical staff can now do what they do best, which is to spend more time with residents.”  (Maine Today Website, 5/17)

 

*  The fashion company Spirited Sisters offers the Original Healing Threads line of garments designed to allow patients to look “as chic at a party as they are practical and comfortable in a hospital room”  The company was formed after two of the sisters were diagnosed with cancer, and will soon expand into children’s hospital wear.  (People, 5/29)

 

Thanks to Carolyn Carter and Jon Krutz for contributions.

 

Glatfelter Insurance Group is the national sponsor of Hospice News Network for 2006.  Glatfelter Insurance Group provides property and liability insurance for hospices and home healthcare agencies through their Hospice and Community Care Insurance Services division.  Ask your insurance agent to visit their website at www.hccis.com.