A model of palliative care for heart failure

The heart failure illness trajectory is both complex and unpredictable, which makes providing palliative care services to patients with heart failure a challenge. As a result, although services are needed, few tend to be offered beyond basic medical management. The traditional model of palliative care is typically based on palliative care being considered a system of care delivery most appropriate for patients with a predictable illness/death trajectory, such as terminal cancer. This type of model, which is based on the ability to predict the course of a terminal disease, does not fit the heart failure trajectory. In this article, we propose a new model of palliative care that conceptualizes palliative care as a philosophy of care that encompasses the unpredictable nature of heart failure. © 2009 The Author(s)

Achieving medical stability: Wives\u27 experiences with heart failure

The incidence of heart failure continues to rise as innovative treatments are developed. Despite life-prolonging interventions, morbidity and mortality in patients younger than 65 remain high. Few studies have focused on this younger cohort and/or their family caregivers as they navigate the complex illness trajectories manifested in heart failure. Instrumental case studies were employed to present exemplars for each of the five identified heart failure trajectories. Culling data from a longitudinal study of female spousal caregivers, each case study represents a wife\u27s discussion of caring for a husband (years) in response to the husband\u27s changing heart failure trajectory. The goal of medical stability and the notion of uncertainty permeate throughout the case studies. Suggestions for supporting these wives are presented. © The Author(s) 2010

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A Model of Palliative Care for Heart Failure

The heart failure illness trajectory is both complex and unpredictable, which makes providing palliative care services to patients with heart failure a challenge. As a result, although services are needed, few tend to be offered beyond basic medical management. The traditional model of palliative care is typically based on palliative care being considered a system of care delivery most appropriate for patients with a predictable illness/death trajectory, such as terminal cancer. This type of model, which is based on the ability to predict the course of a terminal disease, does not fit the heart failure trajectory. In this article, we propose a new model of palliative care that conceptualizes palliative care as a philosophy of care that encompasses the unpredictable nature of heart failure

Ecological Momentary Assessment of Older Women\u27s Health

Living with chronic co-morbidities implies long-lasting, always present conditions associated with highly variable health trajectories. In this study, ecological momentary assessment was used to explore nine older women\u27s experiences of living with co-morbidities. Each participant completed a daily diary, which focused on 10 variables related to energy, pain, effort expended, and an overall health rating, for 21 days. Hierarchical linear modeling was used to explore intra-individual variation in daily health experiences and health-related burden, and determine the extent to which health-related burden was related to daily health experiences. Each of the daily health experience variables sipiificantly predicted health-related burden. Over half of the variation was attributed to the predictor variables. These findings reveal the dynamic nature of living with multiple chronic conditions and demonstrate the utility of daily diaries for measuring fluctuating states of health in community-dwelling older wofnen

Efficiency of Health Care in State Correctional Institutions

Little is known about the efficiency of health care in correction settings. This article reports an efficiency analysis of health care in state correctional institutions (SCIs) in a single, mid-Atlantic state from 2003 to 2006. A two-stage data envelopment analysis was used to estimate the technical efficiency of prison health care and determine inmate and institutional characteristics that were associated with efficiency. Our output variable was the number of infirmary inpatient days for each year of study. The input variable for the first stage was the sum of personnel medical staff costs and other medical operating costs. SCIs with more white prisoners, older prisoners, and higher proportions of inmates with parole violations were significantly less efficient in their provision of health care than other SCIs. There were no SCI characteristics that were predictive of efficiency. These results suggest that healthcare efficiency in corrections may decline as the prison population continues to age