Lisa D DiMartino1, Bryan J Weiner2, Laura C Hanson3, Morris Weinberger4, Sarah A Birken5, Katherine Reeder-Hayes6, Justin G Trogdon7. 1. Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC 27599-7411, USA; RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, USA. Electronic address: ldimartino@rti.org. 2. Department of Global Health, Department of Health Services, Box 357965, University of Washington, Seattle, WA 98195-7965, USA. Electronic address: bjweiner@uw.edu. 3. Division of Geriatric Medicine Center for Aging and Health, UNC Palliative Care Program, 5003 Old Clinic Building, Campus Box 7550, Chapel Hill, NC 27599-7550, USA. Electronic address: lhanson@med.unc.edu. 4. Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC 27599-7411, USA. Electronic address: mweinber@email.unc.edu. 5. Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC 27599-7411, USA. Electronic address: birken@unc.edu. 6. Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Electronic address: kreederh@email.unc.edu. 7. Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC 27599-7411, USA. Electronic address: justintrogdon@unc.edu.
Abstract
INTRODUCTION: Studies show palliative care delivered concurrently with cancer treatment improves outcomes, yet palliative care integration with inpatient oncology is underused. A promising approach to improve integration is a triggered palliative care consultation (TPCC). This study evaluated the impact of two TPCC approaches on consistency and quality of consult implementation, operationalized as uptake and timeliness, on solid tumor medical and gynecologic oncology services at an academic hospital. METHODS: The study timeframe was 2010-2016. TPCC in gynecologic oncology began in 2014 and was supported by a single strategy (written guideline); TPCC in medical oncology began in 2015 and was supported by multiple strategies (e.g. training, chart review). Palliative care consult information was chart abstracted and linked to hospital encounter data. We compared the effect of a single strategy vs. usual care, and multiple strategies vs. a single strategy on implementation. Difference-in-differences modified Poisson regression models evaluated whether implementation differed after TPCC; we estimated adjusted relative risk (aRR), controlling for patient demographic and clinical characteristics. RESULTS: Overall, 8.8% of medical oncology and 11.0% of gynecologic oncology inpatient encounters involved palliative care consultation. In regression analyses, TPCC supported by a single strategy in gynecologic oncology was associated with greater uptake vs. usual care (aRR: 1.45, p < .05), and TPCC supported by multiple strategies in medical oncology was associated with greater uptake vs. a single strategy (aRR: 2.34, p < .001). CONCLUSION: Across two inpatient oncology services, TPCC supported by multiple strategies had the greatest impact on uptake. How strategies affect sustained use of palliative care consults remains to be investigated.
INTRODUCTION: Studies show palliative care delivered concurrently with cancer treatment improves outcomes, yet palliative care integration with inpatient oncology is underused. A promising approach to improve integration is a triggered palliative care consultation (TPCC). This study evaluated the impact of two TPCC approaches on consistency and quality of consult implementation, operationalized as uptake and timeliness, on solid tumor medical and gynecologic oncology services at an academic hospital. METHODS: The study timeframe was 2010-2016. TPCC in gynecologic oncology began in 2014 and was supported by a single strategy (written guideline); TPCC in medical oncology began in 2015 and was supported by multiple strategies (e.g. training, chart review). Palliative care consult information was chart abstracted and linked to hospital encounter data. We compared the effect of a single strategy vs. usual care, and multiple strategies vs. a single strategy on implementation. Difference-in-differences modified Poisson regression models evaluated whether implementation differed after TPCC; we estimated adjusted relative risk (aRR), controlling for patient demographic and clinical characteristics. RESULTS: Overall, 8.8% of medical oncology and 11.0% of gynecologic oncology inpatient encounters involved palliative care consultation. In regression analyses, TPCC supported by a single strategy in gynecologic oncology was associated with greater uptake vs. usual care (aRR: 1.45, p < .05), and TPCC supported by multiple strategies in medical oncology was associated with greater uptake vs. a single strategy (aRR: 2.34, p < .001). CONCLUSION: Across two inpatient oncology services, TPCC supported by multiple strategies had the greatest impact on uptake. How strategies affect sustained use of palliative care consults remains to be investigated.
Authors: J M Grimshaw; L Shirran; R Thomas; G Mowatt; C Fraser; L Bero; R Grilli; E Harvey; A Oxman; M A O'Brien Journal: Med Care Date: 2001-08 Impact factor: 2.983
Authors: Jennifer S Temel; Joseph A Greer; Alona Muzikansky; Emily R Gallagher; Sonal Admane; Vicki A Jackson; Constance M Dahlin; Craig D Blinderman; Juliet Jacobsen; William F Pirl; J Andrew Billings; Thomas J Lynch Journal: N Engl J Med Date: 2010-08-19 Impact factor: 91.245
Authors: R Sean Morrison; Jessica Dietrich; Susan Ladwig; Timothy Quill; Joseph Sacco; John Tangeman; Diane E Meier Journal: Health Aff (Millwood) Date: 2011-03 Impact factor: 6.301
Authors: Hude Quan; Vijaya Sundararajan; Patricia Halfon; Andrew Fong; Bernard Burnand; Jean-Christophe Luthi; L Duncan Saunders; Cynthia A Beck; Thomas E Feasby; William A Ghali Journal: Med Care Date: 2005-11 Impact factor: 2.983
Authors: Marie Bakitas; Kathleen Doyle Lyons; Mark T Hegel; Stefan Balan; Frances C Brokaw; Janette Seville; Jay G Hull; Zhongze Li; Tor D Tosteson; Ira R Byock; Tim A Ahles Journal: JAMA Date: 2009-08-19 Impact factor: 56.272
Authors: Navneet Dhillon; Scott Kopetz; Be Lian Pei; Egidio Del Fabbro; Tao Zhang; Eduardo Bruera Journal: J Palliat Med Date: 2008-03 Impact factor: 2.947
Authors: Lisa D DiMartino; Sarah A Birken; Laura C Hanson; Justin G Trogdon; Alecia S Clary; Morris Weinberger; Katherine Reeder-Hayes; Bryan J Weiner Journal: Health Care Manage Rev Date: 2018 Jul/Sep
Authors: Anna Collins; Vijaya Sundararajan; Brian Le; Linda Mileshkin; Susan Hanson; Jon Emery; Jennifer Philip Journal: Front Oncol Date: 2022-09-15 Impact factor: 5.738