Brooks V Udelsman1, Elizabeth J Lilley2,3, Motaz Qadan4, David C Chang4, Keith D Lillemoe4, Charlotta Lindvall5,6, Zara Cooper2,3. 1. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. budelsman@partners.org. 2. Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA. 3. Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. 4. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. 5. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA. 6. Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Abstract
BACKGROUND: Given survival measured in months, metrics, such as 30-day mortality, are poorly suited to measure the quality of palliative procedures for patients with advanced cancer. Nationally endorsed process measures associated with high-quality PC include code-status clarification, goals-of-care discussions, palliative-care referral, and hospice assessment. The impact of the performance of these process measures on subsequent healthcare utilization is unknown. METHODS: Administrative data and manual review were used to identify hospital admissions with performance of palliative procedures for advanced pancreatic cancer at two tertiary care hospitals from 2011 to 2016. Natural language processing, a form of computer-assisted abstraction, identified process measures in associated free-text notes. Healthcare utilization was compared using a Cox proportional hazard model. RESULTS: We identified 823 hospital admissions with performance of a palliative procedure. PC process measures were identified in 68% of admissions. Patients with documented process measures were older (66 vs. 63; p = 0.04) and had a longer length of stay (9 vs. 6 days; p < 0.001). In multivariate analysis, patients treated by surgeons were less likely to have PC process measures performed (odds ratio 0.19; 95% confidence interval 0.10-0.37). Performance of PC process measures was associated with decreased healthcare utilization in a Cox proportional hazard model. CONCLUSIONS: PC process measures were not performed in almost one-third of hospital admissions for palliative procedures in patients with advanced pancreatic cancer. Performance of established high-quality process measures for seriously ill patients undergoing palliative procedures may help patients to avoid burdensome, high-intensity care at the end-of-life.
BACKGROUND: Given survival measured in months, metrics, such as 30-day mortality, are poorly suited to measure the quality of palliative procedures for patients with advanced cancer. Nationally endorsed process measures associated with high-quality PC include code-status clarification, goals-of-care discussions, palliative-care referral, and hospice assessment. The impact of the performance of these process measures on subsequent healthcare utilization is unknown. METHODS: Administrative data and manual review were used to identify hospital admissions with performance of palliative procedures for advanced pancreatic cancer at two tertiary care hospitals from 2011 to 2016. Natural language processing, a form of computer-assisted abstraction, identified process measures in associated free-text notes. Healthcare utilization was compared using a Cox proportional hazard model. RESULTS: We identified 823 hospital admissions with performance of a palliative procedure. PC process measures were identified in 68% of admissions. Patients with documented process measures were older (66 vs. 63; p = 0.04) and had a longer length of stay (9 vs. 6 days; p < 0.001). In multivariate analysis, patients treated by surgeons were less likely to have PC process measures performed (odds ratio 0.19; 95% confidence interval 0.10-0.37). Performance of PC process measures was associated with decreased healthcare utilization in a Cox proportional hazard model. CONCLUSIONS: PC process measures were not performed in almost one-third of hospital admissions for palliative procedures in patients with advanced pancreatic cancer. Performance of established high-quality process measures for seriously ill patients undergoing palliative procedures may help patients to avoid burdensome, high-intensity care at the end-of-life.
Authors: Tamryn F Gray; Anne Kwok; Khuyen M Do; Sandra Zeng; Edward T Moseley; Yasser M Dbeis; Renato Umeton; James A Tulsky; Areej El-Jawahri; Charlotta Lindvall Journal: JMIR Med Inform Date: 2022-06-15
Authors: Angelo E Volandes; Sophia N Zupanc; Michael K Paasche-Orlow; Joshua R Lakin; Yuchiao Chang; Edith A Burns; Nancy A LaVine; Maria T Carney; Diana Martins-Welch; Kaitlin Emmert; Jennifer E Itty; Edward T Moseley; Aretha D Davis; Areej El-Jawahri; Daniel A Gundersen; Gemmae M Fix; Andrea M Yacoub; Pamela Schwartz; Shira Gabry-Kalikow; Cynthia Garde; Jonathan Fischer; Lori Henault; Leah Burgess; Julie Goldman; Anne Kwok; Nimisha Singh; Armando L Alvarez Suarez; Valeria Gromova; Sonia Jacome; James A Tulsky; Charlotta Lindvall Journal: JAMA Netw Open Date: 2022-02-01
Authors: Joshua R Lakin; Elise N Brannen; James A Tulsky; Michael K Paasche-Orlow; Charlotta Lindvall; Yuchiao Chang; Daniel A Gundersen; Areej El-Jawahri; Angelo Volandes Journal: BMJ Open Date: 2020-07-14 Impact factor: 2.692
Authors: Nwamaka D Eneanya; Joshua R Lakin; Michael K Paasche-Orlow; Charlotta Lindvall; Edward T Moseley; Lori Henault; Amresh D Hanchate; Ernest I Mandel; Susan P Y Wong; Sophia N Zupanc; Aretha Delight Davis; Areej El-Jawahri; Lisa M Quintiliani; Yuchiao Chang; Sushrut S Waikar; Amar D Bansal; Jane O Schell; Andrew L Lundquist; Manjula Kurella Tamura; Margaret K Yu; Mark L Unruh; Christos Argyropoulos; Michael J Germain; Angelo Volandes Journal: BMJ Open Date: 2022-04-08 Impact factor: 2.692