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Predicting a Six-Month Prognosis in Patients with Alzheimer’s Dementia: A Shot in the Dark? (SA518D)
Vol. 53 No. 2 February 2017
Schedule With Abstracts
or septicemia. During these hospitalizations, Whites’ use of mechanical ventilation increased from 3.8% to 10.4% and Blacks’ use increased from 7.6% to 17.1%. Among those ventilated, one-year mortality remained high with 83.9% of Whites vs. 83.7% of Blacks dying in 2012. Compared to Whites, Blacks had a higher odds of receiving mechanical ventilation in the fixed effect (within hospital) model (AOR 1.33; 95% CI 1.27-1.38) and in the model with robust clustering AOR 1.77; 95% 1.63 -1.91). Conclusion. Unlike feeding tube use, mechanical ventilation use among advanced dementia patients has substantially increased, with Blacks having a larger increase compared to Whites that is based, in part, on the hospitals where Blacks receive care.
Implications for research, policy or practice. Reductions in feeding tube use in advanced dementia suggests change is possible and our findings suggest that over-utilization of mechanical ventilation should be the next target. Efforts are needed to ensure that advanced dementia patients receive care consistent with their informed preferences and likely outcomes of care.
Predicting a Six-Month Prognosis in Patients with Alzheimer’s Dementia: A Shot in the Dark? (SA518D) Sonali Wilborn, MBBS MD MBA, Seasons Hospice & Palliative Care, Madison Heights, MI. Navdeep Grewal, MD, Seasons Hospice and Palliative Care, Madison Heights, MI. Objectives Retrospectively analyze our patient data to evaluate the accuracy of the current prognostic indicators used to predict hospice eligibility for patients with Alzheimer’s Dementia. Evaluate for the presence of other clinical criteria that may be used to predict a 6 month prognosis in patients with advanced Alzheimer’s Dementia. Original Research Background. Alzheimer’s Dementia is the second most common non cancer hospice diagnosis (12.5%). With the increased burden of caring for an aging population there is a need to accurately evaluate the prognosis of patients with Alzheimer’s Dementia. Predicting mortality, assessing prognosis is a challenging task for physicians and hospice organizations. Nationally, 25% of patients on hospice with a diagnosis of Dementia had > 6 M LOS. Hospice organizations constantly struggle to follow strict Medicare hospice guidelines while remaining sensitive to the clinical needs of these patients. Research Objectives. Retrospectively analyze our patient data to evaluate the accuracy of current
403
prognostic models, possibly identify other clinical criteria that may accurately predict prognosis in patients with Alzheimer’s Dementia. Methods. A detailed analysis of admission profiles of patients admitted to SH&PC in 2013 under ICD - 9 code 331 (Alzheimer’s Dementia). All patients studied met the current hospice prognostic criteria. Results. 221 patients with Alzheimer’s dementia were identified for analysis. Of these patients, 29% survived longer than six months (mirroring national data) and 71% died within six months. Patients surviving longer than 6 months had mean MMI of 7.7 and those surviving less than six months had a mean MMI of 9.5 (Risk estimates of death within 6 M, 40.4% and 57% respectively). Ethnicity was a significant factor in predicting 6 M prognosis; a much lower percentage of African American patients lived longer than 6 M as compared with other ethnic groups and almost 60% of them resided in NHs. Conclusion. Predicting mortality using current prognostic guidelines, fails in approximately 30% Alzheimer’s patients, indicating a need for additional work in this area
Implications for research, policy or practice. More research into identifying specific, sensitive prognostic models for Alzheimer’s patients. Additionally; we could make the case for allowing for a longer length of stay on hospice (maybe 1 year) for patients with a dementia diagnosis.
2:30e3:30 pm
Concurrent Sessions Using QI Methodology to Standardize Education for Families Considering Tracheostomy Placement and Permanent Mechanical Ventilation for Their Children: An Attempt at Full Disclosure (SA520) Rachel Thienprayoon, MD, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Lesley Doughty, MD, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Hemant Sawnani, MD, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Mark Meyer, MD, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Dan Benscoter, DO, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Marsha Blount, MSN CNP APRN, Cincinnati Children’s Hospital, Cincinnati, OH. Catherine Hart, MD, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Lori Herbst,
Schedule With Abstracts
or septicemia. During these hospitalizations, Whites’ use of mechanical ventilation increased from 3.8% to 10.4% and Blacks’ use increased from 7.6% to 17.1%. Among those ventilated, one-year mortality remained high with 83.9% of Whites vs. 83.7% of Blacks dying in 2012. Compared to Whites, Blacks had a higher odds of receiving mechanical ventilation in the fixed effect (within hospital) model (AOR 1.33; 95% CI 1.27-1.38) and in the model with robust clustering AOR 1.77; 95% 1.63 -1.91). Conclusion. Unlike feeding tube use, mechanical ventilation use among advanced dementia patients has substantially increased, with Blacks having a larger increase compared to Whites that is based, in part, on the hospitals where Blacks receive care.
Implications for research, policy or practice. Reductions in feeding tube use in advanced dementia suggests change is possible and our findings suggest that over-utilization of mechanical ventilation should be the next target. Efforts are needed to ensure that advanced dementia patients receive care consistent with their informed preferences and likely outcomes of care.
Predicting a Six-Month Prognosis in Patients with Alzheimer’s Dementia: A Shot in the Dark? (SA518D) Sonali Wilborn, MBBS MD MBA, Seasons Hospice & Palliative Care, Madison Heights, MI. Navdeep Grewal, MD, Seasons Hospice and Palliative Care, Madison Heights, MI. Objectives Retrospectively analyze our patient data to evaluate the accuracy of the current prognostic indicators used to predict hospice eligibility for patients with Alzheimer’s Dementia. Evaluate for the presence of other clinical criteria that may be used to predict a 6 month prognosis in patients with advanced Alzheimer’s Dementia. Original Research Background. Alzheimer’s Dementia is the second most common non cancer hospice diagnosis (12.5%). With the increased burden of caring for an aging population there is a need to accurately evaluate the prognosis of patients with Alzheimer’s Dementia. Predicting mortality, assessing prognosis is a challenging task for physicians and hospice organizations. Nationally, 25% of patients on hospice with a diagnosis of Dementia had > 6 M LOS. Hospice organizations constantly struggle to follow strict Medicare hospice guidelines while remaining sensitive to the clinical needs of these patients. Research Objectives. Retrospectively analyze our patient data to evaluate the accuracy of current
403
prognostic models, possibly identify other clinical criteria that may accurately predict prognosis in patients with Alzheimer’s Dementia. Methods. A detailed analysis of admission profiles of patients admitted to SH&PC in 2013 under ICD - 9 code 331 (Alzheimer’s Dementia). All patients studied met the current hospice prognostic criteria. Results. 221 patients with Alzheimer’s dementia were identified for analysis. Of these patients, 29% survived longer than six months (mirroring national data) and 71% died within six months. Patients surviving longer than 6 months had mean MMI of 7.7 and those surviving less than six months had a mean MMI of 9.5 (Risk estimates of death within 6 M, 40.4% and 57% respectively). Ethnicity was a significant factor in predicting 6 M prognosis; a much lower percentage of African American patients lived longer than 6 M as compared with other ethnic groups and almost 60% of them resided in NHs. Conclusion. Predicting mortality using current prognostic guidelines, fails in approximately 30% Alzheimer’s patients, indicating a need for additional work in this area
Implications for research, policy or practice. More research into identifying specific, sensitive prognostic models for Alzheimer’s patients. Additionally; we could make the case for allowing for a longer length of stay on hospice (maybe 1 year) for patients with a dementia diagnosis.
2:30e3:30 pm
Concurrent Sessions Using QI Methodology to Standardize Education for Families Considering Tracheostomy Placement and Permanent Mechanical Ventilation for Their Children: An Attempt at Full Disclosure (SA520) Rachel Thienprayoon, MD, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Lesley Doughty, MD, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Hemant Sawnani, MD, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Mark Meyer, MD, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Dan Benscoter, DO, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Marsha Blount, MSN CNP APRN, Cincinnati Children’s Hospital, Cincinnati, OH. Catherine Hart, MD, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. Lori Herbst,