Meena Kalluri1, Francisca Claveria2, Emily Ainsley2, Maged Haggag3, Susan Armijo-Olivo4, Janice Richman-Eisenstat3. 1. Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: kalluri@ualberta.ca. 2. Department of Physiology, University of Alberta, Edmonton, Alberta, Canada. 3. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 4. University of Alberta, Institute of Health Economics, Edmonton, Alberta, Canada.
Abstract
CONTEXT: Idiopathic pulmonary fibrosis (IPF) is a progressive, incurable interstitial lung disease with heavy symptom burden and poor quality of life. The last year of life is characterized by increased acute care utilization and hospital deaths. Clinical guidelines recommend early integration of palliative care but are rarely implemented. In 2012, we reorganized our clinic into a multidisciplinary team comprising two pulmonologists (expertise in interstitial lung disease and palliative respiratory care, respectively), nurse, respiratory therapist, physiotherapist, and a dietitian. We adopted an early integrated palliative approach with a focus on early symptom management and advance care planning starting at the first clinic visit. We designed a Multidisciplinary collaborative (MDC) care model with emphasis on community-based care to manage patients in their homes and support caregivers. OBJECTIVES: Exploratory analysis of this model's association with acute care utilization in the last year of life and location of death was undertaken. METHODS: Data from deceased IPF patients before and after 2012 (non-MDC and MDC care model, respectively) were collected, and statistical analysis was performed. RESULTS: Patients in MDC care were 24.2 times less likely to have respiratory-related emergency room visits (95% CI: 3.12-187.44, P = 0.002), 2.32 times less likely to have respiratory-related hospitalizations (95% CI: 0.95-5.6, P = 0.064). The odds of achieving a home or hospice death in MDC care were 9.2 times compared to non-MDC care, who die mostly in the hospital (95% CI: 1.14-75, P = 0.037). CONCLUSIONS: MDC care model for IPF was associated with reduced health care use in the last year of life and more home deaths.
CONTEXT: Idiopathic pulmonary fibrosis (IPF) is a progressive, incurable interstitial lung disease with heavy symptom burden and poor quality of life. The last year of life is characterized by increased acute care utilization and hospital deaths. Clinical guidelines recommend early integration of palliative care but are rarely implemented. In 2012, we reorganized our clinic into a multidisciplinary team comprising two pulmonologists (expertise in interstitial lung disease and palliative respiratory care, respectively), nurse, respiratory therapist, physiotherapist, and a dietitian. We adopted an early integrated palliative approach with a focus on early symptom management and advance care planning starting at the first clinic visit. We designed a Multidisciplinary collaborative (MDC) care model with emphasis on community-based care to manage patients in their homes and support caregivers. OBJECTIVES: Exploratory analysis of this model's association with acute care utilization in the last year of life and location of death was undertaken. METHODS: Data from deceased IPF patients before and after 2012 (non-MDC and MDC care model, respectively) were collected, and statistical analysis was performed. RESULTS:Patients in MDC care were 24.2 times less likely to have respiratory-related emergency room visits (95% CI: 3.12-187.44, P = 0.002), 2.32 times less likely to have respiratory-related hospitalizations (95% CI: 0.95-5.6, P = 0.064). The odds of achieving a home or hospice death in MDC care were 9.2 times compared to non-MDC care, who die mostly in the hospital (95% CI: 1.14-75, P = 0.037). CONCLUSIONS: MDC care model for IPF was associated with reduced health care use in the last year of life and more home deaths.
Authors: Federica Furini; Aldo Carnevale; Gian Luca Casoni; Giulio Guerrini; Lorenzo Cavagna; Marcello Govoni; Carlo Alberto Sciré Journal: Front Med (Lausanne) Date: 2019-10-31
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