Improving Palliative Care with Deep Learning

Improving the quality of end-of-life care for hospitalized patients is a priority for healthcare organizations. Studies have shown that physicians tend to over-estimate prognoses, which in combination with treatment inertia results in a mismatch between patients wishes and actual care at the end of life. We describe a method to address this problem using Deep Learning and Electronic Health Record (EHR) data, which is currently being piloted, with Institutional Review Board approval, at an academic medical center. The EHR data of admitted patients are automatically evaluated by an algorithm, which brings patients who are likely to benefit from palliative care services to the attention of the Palliative Care team. The algorithm is a Deep Neural Network trained on the EHR data from previous years, to predict all-cause 3-12 month mortality of patients as a proxy for patients that could benefit from palliative care. Our predictions enable the Palliative Care team to take a proactive approach in reaching out to such patients, rather than relying on referrals from treating physicians, or conduct time consuming chart reviews of all patients. We also present a novel interpretation technique which we use to provide explanations of the model's predictions.Comment: IEEE International Conference on Bioinformatics and Biomedicine 201

Technology-Based End-of-Life Planning for an Underserved Population

Problem: Research indicates a low-income status and ethnic and racial diversity is a barrier to ACP engagement. Context: This project took place at a Federally Qualified Heath Center located in Northern California which serves approximately 200,000 diverse and economically disadvantaged patients. Methods: The primary intervention was dissemination of an email to patients 50 and older, via their health system email account. The email included a direct link to PREPARE, an online advance care planning technology tool. A secondary intervention was a presentation to primary care providers that focused on end-of-life-care planning tools and communication strategies. Results: The email was distributed to 22,296 patients and received a total of 895 clicks on the link to PREPARE. Pre- and post-email data did not show a significant change in ACP engagement. The provider presentation pre-and post-survey results revealed an increase in mean scores for comfort with ACP discussions, best practices for ACP discussion, and communication resources. Conclusions: Engaging patients in ACP is a persistent challenge for primary care providers working with diverse groups within healthcare systems. As the U.S. geriatric population becomes larger and more diverse, advance health care planning needs to be prioritized in a culturally sensitive manner

Components of palliative care interventions addressing the needs of people with dementia living in long term care: a systematic review

© The Author(s) 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).Background: People with dementia requiring palliative care havemultiple needs that require complex, multicomponent interventions. Thisneed is amplified in the long term care setting. The European Associationfor Palliative Care (EAPC) White Paper offers recommendations forpalliative care in dementia and highlights domains of care integral forthis population, thus providing useful guidance to developing suchinterventions. This review maps components of palliative careinterventions for people with dementia in LTCFs, with a particular focuson shared decision-making.Peer reviewe

Complex Care Management Program Overview

This report includes brief updates on various forms of complex care management including: Aetna - Medicare Advantage Embedded Case Management ProgramBrigham and Women's Hospital - Care Management ProgramIndependent Health - Care PartnersIntermountain Healthcare and Oregon Health and Science University - Care Management PlusJohns Hopkins University - Hospital at HomeMount Sinai Medical Center -- New York - Mount Sinai Visiting Doctors Program/ Chelsea-Village House Calls ProgramsPartners in Care Foundation - HomeMeds ProgramPrinceton HealthCare System - Partnerships for PIECEQuality Improvement for Complex Chronic Conditions - CarePartner ProgramSenior Services - Project Enhance/EnhanceWellnessSenior Whole Health - Complex Care Management ProgramSumma Health/Ohio Department of Aging - PASSPORT Medicaid Waiver ProgramSutter Health - Sutter Care Coordination ProgramUniversity of Washington School of Medicine - TEAMcar

Quality of Health Care for Medicare Beneficiaries: A Chartbook

Provides the results of a review of recently published studies and reports about the quality of health care for elderly Medicare beneficiaries. Includes examples of deficiencies and disparities in care, and some promising quality improvement initiatives

International Profiles of Health Care Systems, 2012

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, care coordination, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

End-of-life care and dementia

In the UK, research continues to confirm that people with certain chronic illnesses, such as chronic lung disease and cardiac failure, represent the ‘disadvantaged dying’ compared to those with terminal cancer. But what is the situation for people dying with advanced dementia and what is the experience of their carers? Practical guidance for clinicians is scarce. In Standard 7 of the National Service Framework for Older People, which covers mental health, there is mention neither of how care should be provided nor of how patient choice should be ensured for people with dementia at the end of life. In the UK, 5% of the population aged 65 and over and 20% of those aged 80 and over have dementia similar prevalence figures are found in the USA. Current predictions suggest that the number of people with dementia will increase by 40% by 2026 and will double by 2050. The increased demand for end-of-life care for people with dementia will be associated with major social and economic costs, but what is the current standard of such care? How can the quality be improved? And how should future services be configured to cope with this increasing need? In this paper, we review current knowledge around end-of-life care in dementia, discuss the clinical challenges and ethical dilemmas presented to carers, consider the difficulties in delivering such care and suggest practical approaches to improve the quality of such care

Dying and death in the electronic patient record. A qualitative analysis of textual practices

All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, without permission.In Norway, over one in four deaths occur in hospitals, places that operate primarily according to curative logic. One aim of the Norwegian health care system is that patients, at the end of life, should receive high-quality palliative care as defined by the World Health Organization, independent of whether they are dying at home or in a nursing home, hospice or hospital. Against this potentially challenging background, this project investigates the role of the texts about such patients written into the electronic patient record (EPR). Starting from the view of (EPR) texts as active contributors to the whereabouts of (dying) patients, the EPR can be seen as an essential communication and coordination tool contributing to the types of knowledge that circulate about the dying patient and their treatment. This thesis aims to provide insights into how and what knowledge the EPR proposes as relevant by asking: What kind of textual practices of dying and death in medical wards are present in the EPR, and what do these practices achieve? The selected methods were a qualitative document analysis combining elements from the fields of linguistics, literary criticism and science and technology studies. This effort resulted in three articles elaborating different aspects of how dying and death are documented in the EPR. The first article investigated the negotiations of the transition from curative to palliative care. It argued that the text often changes from being technical and conclusive to being uncertain and open to negotiations as a need to align the involved parties in the decision. The second article explored which aspects of dying the text is attuned to in patients’ last 24 hours of life. It argued that the text has three hegemonic modes of ordering – numbering, timing, and classifying – which perform a dominant narrative in which dying is concealed. Yet, in between, there are traces of caring attention to and compassion for the dying patient. The third article considered how the moment of death is documented. It argued for what seem to be established ways of recording this moment as being manageable and portraying it as uneventful or good. This exploration of textual practices suggests that, first, the EPR treats dying and death as observations and tasks to be solved in general biomedical terms, rather than probing the needs of the individual patient. Second, the EPR seems to avoid difficult topics, deliberations, and disagreements, and it never admits to failure. Finally, the EPR sometimes shows professionals’ attempts to reveal individual patients’ needs and suffering and the troubles of dying in a curative context. Paper I: Hov, L., Synnes, O., & Aarseth, G. (2020). Negotiating the turning point in the transition from curative to palliative treatment: A linguistic analysis of medical records of dying patients. BMC Palliative Care, 19 (1), 1–13. https://doi.org/10.1186/s12904-020-00602-4 Paper II: Hov, L., Pasveer, B., & Synnes, O. (2020). Modes of dying in the electronic patient record, Mortality, https://doi.org/10.1080/13576275.2020.1865294 Paper III: Hov, L., Tveit, B., & Synnes O. (2021, May). Nobody dies alone in the electronic patient record – A qualitative analysis of the textual practices of documenting dying and death. OMEGA-Journal of Death and Dying. https://doi.org/10.1177/00302228211019197publishedVersio

Challenges and Pitfalls for Implementing Digital Health Solutions in Clinical Studies in Europe

(...