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Hospice Caregivers Experiences and Perceptions of Pain Medication Administration (S746)
Vol. 45 No. 2 February 2013
Poster Abstracts
Implications for Research, Policy, or Practice. Policy and practice modifications to increase E-kit utilization and standardize contents constitute opportunities for further research and intervention to enhance patient care. Once guidelines are in place, additional cost-effectiveness studies may also prove useful.
How Many People Need Palliative Care? A Refined Method to Estimate the Size of a Palliative Care Population Nationally (S745) Fliss Murtagh, PhD, King’s College London, London, England, UK. Claudia Bausewein, PhD, University of Munich, Munich, Bavaria. Julia Verne, PhD MBBS MSc BSc FFPH, South West Public Health Observatory, Bristol, Glos. Yvonne Kaloki, MSc, King’s College London, London, England, UK. E. Iris Groeneveld, MSc, King’s College London, London, England, UK. Irene Higginson, PhD BMedSci BMBS FFPHM FRCP, Cicely Saunders Institute, London, England, UK. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Develop and refine an internationally applicable method to estimate population-level palliative care need. 2. Relate this methodology to national healthcare planning, commissioning and assessments of future palliative services. Research Objectives. To refine an internationally applicable method for estimating palliative care need in a national population, including malignant and non-malignant conditions Method. Using secondary data analysis, we adapted Rosenwax’s 1 estimation method of deriving minimum, mid-range, and maximum estimates of population need. We applied this to all deaths in England between 1 Jan 2006 and 31 Dec 2008 using Linked Hospital Episode Statistics/Office for National Statistics Mortality file, supplied by the National Health Service Information Centre Result. 1) Minimum estimate: this is a more accurate and detailed breakdown of ICD10 codes (compared to Rosenwax1) to encompass eight main disease categories needing palliative care. 2) Lower mid-range estimate: this extends the low estimate by including cases admitted to hospital with the same condition in the year before death, in addition to Alzheimer’s, dementia,
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senility or chronic renal failure deaths recorded as a contributory cause. 3) Upper mid-range estimate: this includes all deaths with any mention of the ICD10 disease categories used in (1) as underlying or contributory cause of death in the death certificate. 4) Maximum estimate: this captures all deaths except those during pregnancy and childbirth, puerperal deaths and deaths from accidents and external causes. Using this methodology, our minimum estimate highlights that 63% of all deaths (297,985 per annum) need palliative care. The lower and upper mid-range estimates projects 69% and 82% of all deaths (between 326,685 and 387,067 deaths per annum). The maximum population estimate projects 97% of all deaths (456,767 deaths per annum). Conclusion. We have successfully refined and applied a methodology for estimating the national population requiring palliative care. This is applicable to any country where linked hospital episode and mortality data are available. This provides valuable information to aid planning for future palliative care services. 1. Rosenwax. Palliative Medicine. 2005.
Hospice Caregivers Experiences and Perceptions of Pain Medication Administration (S746) Debra Parker Oliver, MSW PhD, University of Missouri, Columbia, MO. Elaine WittenbergLyles, PhD, University of Kentucky, Lexington, KY. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Discuss the narratives shared by hospice caregivers regarding their challenges in administering pain medications. 2. Discuss the implication of negative caregiver experience with pain medications. 3. Identify two strategies for improving the administration of pain medications for hospice caregivers. Background. Hospice caregivers face numerous challenges as they manage a dying patient, most often in their home environment, 24 hours a day. Typically family members or friends, these caregivers are untrained in the management of terminal illness. It has been documented that caregivers struggle with pain assessment, fear of administering medication, noncompliance with pain medicine regimens, and the reporting of pain to the hospice team.
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Poster Abstracts
Research Objectives. The objective of this project was to understand the nature of the perceptions and experiences of hospice caregivers administering pain medications to their loved ones. Method. Caregivers were interviewed by phone 30 days following the death of their hospice patient. One hundred fifty caregivers were asked about their experience with hospice and their challenges managing pain for their loved one. Narratives were coded and analyzed for emerging themes. Result. Following medication schedules, understanding pain medicine protocols, and fear in assessing their loved ones pain emerged as themes from the analysis. Powerful narratives will be shared demonstrating caregiver frustration, fear, and guilt over the administration of narcotics. Conclusion. While happy with their hospice care, many caregivers reported believing that a final dose of morphine hastened the death of their loved one. Implications for Research, Policy, or Practice. Implications from these narratives challenge hospice teams to build additional education and support for caregivers into their plans of care. Education on pain management which is understood and accessible for caregivers is needed.
Impact of the Face-to-Face Physician Visit Requirement on Recertifications and Discharge Status (S747) Michael Plotzke, PhD, Abt Associates, Cambridge, MA. Anjana Patel, MPH, Centers for Medicare and Medicaid Services, Baltimore, MD. Katherine Lucas, PhD, Centers for Medicare and Medicaid Services, Baltimore, MD. Zinnia Ng Harrison, MHS DHHS, Centers for Medicare and Medicaid Services, Baltimore, MD. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. To inform the hospice and palliative medicine community about the effects of the Face-to-Face Physician Visit Requirement on recertification of hospice benefit periods. 2. To better understand the impact of the Faceto-Face Physician Visit Requirement on discharge status as reported on the hospice claim.
Vol. 45 No. 2 February 2013
Background. The Affordable Care Act (ACA) mandated a Face-to-Face (F2F) Physician Visit Requirement for Hospice that requires a beneficiary to have a face-to-face visit with a hospice physician or nurse practitioner prior to the third and any subsequent recertification. The requirement was effective January 1, 2011. By April 1, 2011 hospices were expected to have fully established internal processes for face-to-face and provide appropriate documentation. Research Objectives. The analysis attempts to answer a specific question that should provide information on the impact of F2F: Is the frequency of a second or subsequent recertification greater for beneficiaries who began their first benefit period during October 2009-January 2010 compared to beneficiaries who began their first benefit period during October 2010-January 2011? Method. 100% of Medicare FFS Hospice Claims from 2010-2010 were used to look at the timing of recertification periods. Result. A similar number of benefit periods started between 2009 and 2010 compared to 2010 and 2011. However, the percentage of beneficiaries who did not make it past their second benefit period is nearly identical between the two time periods (24.5% for those not affected by F2F versus 24.8% for those affected). The beneficiaries affected by F2F have a slightly higher percentage of benefit periods ending in live discharge (11.2% versus 10.3%) or ‘‘still in hospice’’ (76.2% versus 75.9%) but a slightly lower percentage of benefit periods ending in death (12.5% versus 13.6%) compared to the beneficiaries not affected by F2F. Conclusion. The F2F requirement has no significant impact on number of recertifications and discharge status.
Implications for Research, Policy, or Practice. As the F2F requirement continues to be carried out, researchers should continue to monitor the system to understand any effects the requirement has.
Family Conferences: Impact on Family Distress and Satisfaction (S748) Ruth Powazki, MSW LISW, Cleveland Clinic Foundation, Cleveland, OH. Declan Walsh, MSc FACP FRCP(Edin), Cleveland Clinic Taussig Cancer Institute, Cleveland, OH. Aynur Aktas, MD, Cleveland Clinic Taussig Cancer
Poster Abstracts
Implications for Research, Policy, or Practice. Policy and practice modifications to increase E-kit utilization and standardize contents constitute opportunities for further research and intervention to enhance patient care. Once guidelines are in place, additional cost-effectiveness studies may also prove useful.
How Many People Need Palliative Care? A Refined Method to Estimate the Size of a Palliative Care Population Nationally (S745) Fliss Murtagh, PhD, King’s College London, London, England, UK. Claudia Bausewein, PhD, University of Munich, Munich, Bavaria. Julia Verne, PhD MBBS MSc BSc FFPH, South West Public Health Observatory, Bristol, Glos. Yvonne Kaloki, MSc, King’s College London, London, England, UK. E. Iris Groeneveld, MSc, King’s College London, London, England, UK. Irene Higginson, PhD BMedSci BMBS FFPHM FRCP, Cicely Saunders Institute, London, England, UK. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Develop and refine an internationally applicable method to estimate population-level palliative care need. 2. Relate this methodology to national healthcare planning, commissioning and assessments of future palliative services. Research Objectives. To refine an internationally applicable method for estimating palliative care need in a national population, including malignant and non-malignant conditions Method. Using secondary data analysis, we adapted Rosenwax’s 1 estimation method of deriving minimum, mid-range, and maximum estimates of population need. We applied this to all deaths in England between 1 Jan 2006 and 31 Dec 2008 using Linked Hospital Episode Statistics/Office for National Statistics Mortality file, supplied by the National Health Service Information Centre Result. 1) Minimum estimate: this is a more accurate and detailed breakdown of ICD10 codes (compared to Rosenwax1) to encompass eight main disease categories needing palliative care. 2) Lower mid-range estimate: this extends the low estimate by including cases admitted to hospital with the same condition in the year before death, in addition to Alzheimer’s, dementia,
445
senility or chronic renal failure deaths recorded as a contributory cause. 3) Upper mid-range estimate: this includes all deaths with any mention of the ICD10 disease categories used in (1) as underlying or contributory cause of death in the death certificate. 4) Maximum estimate: this captures all deaths except those during pregnancy and childbirth, puerperal deaths and deaths from accidents and external causes. Using this methodology, our minimum estimate highlights that 63% of all deaths (297,985 per annum) need palliative care. The lower and upper mid-range estimates projects 69% and 82% of all deaths (between 326,685 and 387,067 deaths per annum). The maximum population estimate projects 97% of all deaths (456,767 deaths per annum). Conclusion. We have successfully refined and applied a methodology for estimating the national population requiring palliative care. This is applicable to any country where linked hospital episode and mortality data are available. This provides valuable information to aid planning for future palliative care services. 1. Rosenwax. Palliative Medicine. 2005.
Hospice Caregivers Experiences and Perceptions of Pain Medication Administration (S746) Debra Parker Oliver, MSW PhD, University of Missouri, Columbia, MO. Elaine WittenbergLyles, PhD, University of Kentucky, Lexington, KY. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Discuss the narratives shared by hospice caregivers regarding their challenges in administering pain medications. 2. Discuss the implication of negative caregiver experience with pain medications. 3. Identify two strategies for improving the administration of pain medications for hospice caregivers. Background. Hospice caregivers face numerous challenges as they manage a dying patient, most often in their home environment, 24 hours a day. Typically family members or friends, these caregivers are untrained in the management of terminal illness. It has been documented that caregivers struggle with pain assessment, fear of administering medication, noncompliance with pain medicine regimens, and the reporting of pain to the hospice team.
446
Poster Abstracts
Research Objectives. The objective of this project was to understand the nature of the perceptions and experiences of hospice caregivers administering pain medications to their loved ones. Method. Caregivers were interviewed by phone 30 days following the death of their hospice patient. One hundred fifty caregivers were asked about their experience with hospice and their challenges managing pain for their loved one. Narratives were coded and analyzed for emerging themes. Result. Following medication schedules, understanding pain medicine protocols, and fear in assessing their loved ones pain emerged as themes from the analysis. Powerful narratives will be shared demonstrating caregiver frustration, fear, and guilt over the administration of narcotics. Conclusion. While happy with their hospice care, many caregivers reported believing that a final dose of morphine hastened the death of their loved one. Implications for Research, Policy, or Practice. Implications from these narratives challenge hospice teams to build additional education and support for caregivers into their plans of care. Education on pain management which is understood and accessible for caregivers is needed.
Impact of the Face-to-Face Physician Visit Requirement on Recertifications and Discharge Status (S747) Michael Plotzke, PhD, Abt Associates, Cambridge, MA. Anjana Patel, MPH, Centers for Medicare and Medicaid Services, Baltimore, MD. Katherine Lucas, PhD, Centers for Medicare and Medicaid Services, Baltimore, MD. Zinnia Ng Harrison, MHS DHHS, Centers for Medicare and Medicaid Services, Baltimore, MD. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. To inform the hospice and palliative medicine community about the effects of the Face-to-Face Physician Visit Requirement on recertification of hospice benefit periods. 2. To better understand the impact of the Faceto-Face Physician Visit Requirement on discharge status as reported on the hospice claim.
Vol. 45 No. 2 February 2013
Background. The Affordable Care Act (ACA) mandated a Face-to-Face (F2F) Physician Visit Requirement for Hospice that requires a beneficiary to have a face-to-face visit with a hospice physician or nurse practitioner prior to the third and any subsequent recertification. The requirement was effective January 1, 2011. By April 1, 2011 hospices were expected to have fully established internal processes for face-to-face and provide appropriate documentation. Research Objectives. The analysis attempts to answer a specific question that should provide information on the impact of F2F: Is the frequency of a second or subsequent recertification greater for beneficiaries who began their first benefit period during October 2009-January 2010 compared to beneficiaries who began their first benefit period during October 2010-January 2011? Method. 100% of Medicare FFS Hospice Claims from 2010-2010 were used to look at the timing of recertification periods. Result. A similar number of benefit periods started between 2009 and 2010 compared to 2010 and 2011. However, the percentage of beneficiaries who did not make it past their second benefit period is nearly identical between the two time periods (24.5% for those not affected by F2F versus 24.8% for those affected). The beneficiaries affected by F2F have a slightly higher percentage of benefit periods ending in live discharge (11.2% versus 10.3%) or ‘‘still in hospice’’ (76.2% versus 75.9%) but a slightly lower percentage of benefit periods ending in death (12.5% versus 13.6%) compared to the beneficiaries not affected by F2F. Conclusion. The F2F requirement has no significant impact on number of recertifications and discharge status.
Implications for Research, Policy, or Practice. As the F2F requirement continues to be carried out, researchers should continue to monitor the system to understand any effects the requirement has.
Family Conferences: Impact on Family Distress and Satisfaction (S748) Ruth Powazki, MSW LISW, Cleveland Clinic Foundation, Cleveland, OH. Declan Walsh, MSc FACP FRCP(Edin), Cleveland Clinic Taussig Cancer Institute, Cleveland, OH. Aynur Aktas, MD, Cleveland Clinic Taussig Cancer