Preliminary Report of a Palliative Care and Case Management Project in an Emergency Department for Chronically Ill Elderly Patients

This study identified differences in functional status with regard to referral and enrollment on hospice and homecare

Sean O’ Mahony

2008

Scholarcy highlights

  • With the aging of the population and decrease in the length of hospitalizations, greater numbers of older adults are managing multiple chronic conditions in the community with increasing levels of disability. They are vulnerable because of strained caregiver systems, limited decisional capacity, and financial resources.Older adults with chronic progressive illnesses often lack coordination of care
  • We used a component of the information systems, called Clinical Looking Glass, which matches with the Social Security Death Index to capture patient deaths that occurred outside Montefiore Medical Center
  • Patient Characteristics Patient characteristics are presented in Table 2; 52% lived in their own residence, 38.9% lived in a skilled nursing facility, and 7.9% lived in the home of a family member
  • Significant proportions of older patients who visit the emergency department for complaints related to chronic illnesses can be expected to have limited likelihood of survival
  • There was some evidence to suggest that the provision of palliative care and case management services in an urban ED was associated with increased patient and family satisfaction with symptom relief and increased uptake of hospital-based palliative care services and hospice
  • A score of 60% or less on the domains of this scale correlates with a physician estimate of survival of 180 days or less
  • There was limited impact on utilization of acute care for the patients enrolled in this pilot study
  • There was some evidence to suggest that the provision of palliative care and case management services in an urban emergency department was associated with increased patient and family satisfaction with symptom relief and increased uptake of hospital-based palliative care services and hospice

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