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P346 The Fast Cognitive Assessment (Face), A New Brief and Reliable Cognitive Measurement Scale
Vol. 52 No. 6 December 2016
Selected Abstracts
Conclusion: The findings show that the tool is useful for the primary level palliative care providers although it is a small sample. Its format could be improved and further research can be made to better understand other aspects of successful implementation.
P346 The Fast Cognitive Assessment (Face), A New Brief and Reliable Cognitive Measurement Scale Amel Baghdadli, Gabrielle Dumas, Giovanni G. Arcuri, Cinthia Lacroix, Fabienne Jolicoeur, Ren ee Drolet, Joanie Le Moignan, Bruno Gagnon, Universite Laval, Que bec, QC, Canada Cognitive deficits are prevalent in patients with cancer all along their trajectory. Specific cognitive functions are affected in this population. Several questionnaires are used to assess cognitive impairment but they are not adapted for this population. We developed a simple, easily administrable, short and reliable cognitive test, the Fast Cognitive Evaluation (FaCE), using Rasch analysis. A primary version of the FaCE which assesses the most impaired cognitive aspects in patients with cancer, such as, attention, concentration, visuo-spacial functioning, immediate memory and recall was created. This version has been improved by selecting the fewest items needed to assess each cognitive aspect and by suppressing the redundant items using the Rasch model. The Rasch model is a psychometric mathematical method that establishes the conditions that a measurement tool has to satisfy to be considered a rating scale: the numerical scale is linear with equal intervals.
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P347 Developing an Integrative Model for Supportive and Palliative Care (SPC) in the Emergency Department (ED) Shawnta Pittman-Hobbs, Sommer Smith, John Tracy, Glenn Calabrese, Kimberly Montgomery, Danielle Reed, Nemie Roberts, Chuck Wallace, Kent Palmore, Baylor Scott and White All Saints Medical CentereFort Worth, Fort Worth, TX, United States Background: The ED is no longer utilized primarily for acute emergencies. Patients with chronic illnesses utilize ED for management of distressing symptoms, care-planning needs, and end-of-life care. Objective: To implement an integrative approach for SPC in the ED, fostering partnership without delay of traditional ED work flow, reducing overall length of stay, and most importantly improving patient-centered care. Methods: ED-specific training and screening tools were developed: Triggers for consultation based on preset criteria were embedded in MEDHOST documentation system In-services were provided to ED staff for identification of appropriate patients Periodic ED visits were made by SPC staff for familiarization with ED workflow SPC participation in ED Taskforce monthly meetings Identification and involvement of ED champion physician in SPC committee meetings
The results performed on 165 patients with different types and stages of cancer show that the FaCE is a linear and uni-dimensional measurement scale. The mean duration to complete the questionnaire is less than 6 minutes. The sample is large enough to confirm the item difficulty hierarchy with precisely located items (item-separation-index ¼ 8.14, item-reliability ¼ 0.99). The FaCE distinguishes high and low performers with enough levels (person-separation-index ¼ 2.53, person-reliability ¼ 0.86). The item-map shows no gap or ceiling effect.
Results: The average number of SPC consults triggered in the ED increased significantly; from a baseline of 0 to 7.3 per month between July 2013 - Dec 2013, to 9.4 per month for calendar year (CY) 2014, to 11.2 in CY15, and 14.3 in CY16. There were over 300 consultations, which exceeded original goal by 25%. Retrospective chart review found patients with ED-based SPC consultation had reduction in average length of stay (ALOS) by 33% when compared to consultation later in admission. The differences between both ED and Non-ED patients in ALOS were significantly different, p-value LT 0.05 and 95% Confidence Interval. Review of Press Ganey results demonstrated 97th national percentile ranking in patients’ perception of respect and courtesy by doctors a marker of quality care.
The FaCE is a new tool which quickly assesses with excellent accuracy the specific cognitive impairment in patients with cancer. Using the FaCE to monitor the cognitive functions in this population might improve their treatment and follow-up. The FaCE could also be considered a reliable measurement scale in research that explores cognitive disorders.
Conclusions: ED-based SPC has not been studied extensively nor implemented universally. The presented model of SPC integration in the ED demonstrates one possible approach to successful partnership amongst departments with traditionally opposing perspectives. This union was shown to promote efficiency and provide excellent patient-centered care.
Selected Abstracts
Conclusion: The findings show that the tool is useful for the primary level palliative care providers although it is a small sample. Its format could be improved and further research can be made to better understand other aspects of successful implementation.
P346 The Fast Cognitive Assessment (Face), A New Brief and Reliable Cognitive Measurement Scale Amel Baghdadli, Gabrielle Dumas, Giovanni G. Arcuri, Cinthia Lacroix, Fabienne Jolicoeur, Ren ee Drolet, Joanie Le Moignan, Bruno Gagnon, Universite Laval, Que bec, QC, Canada Cognitive deficits are prevalent in patients with cancer all along their trajectory. Specific cognitive functions are affected in this population. Several questionnaires are used to assess cognitive impairment but they are not adapted for this population. We developed a simple, easily administrable, short and reliable cognitive test, the Fast Cognitive Evaluation (FaCE), using Rasch analysis. A primary version of the FaCE which assesses the most impaired cognitive aspects in patients with cancer, such as, attention, concentration, visuo-spacial functioning, immediate memory and recall was created. This version has been improved by selecting the fewest items needed to assess each cognitive aspect and by suppressing the redundant items using the Rasch model. The Rasch model is a psychometric mathematical method that establishes the conditions that a measurement tool has to satisfy to be considered a rating scale: the numerical scale is linear with equal intervals.
e157
P347 Developing an Integrative Model for Supportive and Palliative Care (SPC) in the Emergency Department (ED) Shawnta Pittman-Hobbs, Sommer Smith, John Tracy, Glenn Calabrese, Kimberly Montgomery, Danielle Reed, Nemie Roberts, Chuck Wallace, Kent Palmore, Baylor Scott and White All Saints Medical CentereFort Worth, Fort Worth, TX, United States Background: The ED is no longer utilized primarily for acute emergencies. Patients with chronic illnesses utilize ED for management of distressing symptoms, care-planning needs, and end-of-life care. Objective: To implement an integrative approach for SPC in the ED, fostering partnership without delay of traditional ED work flow, reducing overall length of stay, and most importantly improving patient-centered care. Methods: ED-specific training and screening tools were developed: Triggers for consultation based on preset criteria were embedded in MEDHOST documentation system In-services were provided to ED staff for identification of appropriate patients Periodic ED visits were made by SPC staff for familiarization with ED workflow SPC participation in ED Taskforce monthly meetings Identification and involvement of ED champion physician in SPC committee meetings
The results performed on 165 patients with different types and stages of cancer show that the FaCE is a linear and uni-dimensional measurement scale. The mean duration to complete the questionnaire is less than 6 minutes. The sample is large enough to confirm the item difficulty hierarchy with precisely located items (item-separation-index ¼ 8.14, item-reliability ¼ 0.99). The FaCE distinguishes high and low performers with enough levels (person-separation-index ¼ 2.53, person-reliability ¼ 0.86). The item-map shows no gap or ceiling effect.
Results: The average number of SPC consults triggered in the ED increased significantly; from a baseline of 0 to 7.3 per month between July 2013 - Dec 2013, to 9.4 per month for calendar year (CY) 2014, to 11.2 in CY15, and 14.3 in CY16. There were over 300 consultations, which exceeded original goal by 25%. Retrospective chart review found patients with ED-based SPC consultation had reduction in average length of stay (ALOS) by 33% when compared to consultation later in admission. The differences between both ED and Non-ED patients in ALOS were significantly different, p-value LT 0.05 and 95% Confidence Interval. Review of Press Ganey results demonstrated 97th national percentile ranking in patients’ perception of respect and courtesy by doctors a marker of quality care.
The FaCE is a new tool which quickly assesses with excellent accuracy the specific cognitive impairment in patients with cancer. Using the FaCE to monitor the cognitive functions in this population might improve their treatment and follow-up. The FaCE could also be considered a reliable measurement scale in research that explores cognitive disorders.
Conclusions: ED-based SPC has not been studied extensively nor implemented universally. The presented model of SPC integration in the ED demonstrates one possible approach to successful partnership amongst departments with traditionally opposing perspectives. This union was shown to promote efficiency and provide excellent patient-centered care.