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Specialty Palliative Care Consultations for Nursing Home Residents With Dementia
Miller SC, Lima JC, Intrator O, Martin E, Bull J, Hanson LC.. Journal of pain and symptom management, 2017-04-22
Topic: Risk, prevention and care in population studies
Context U.S. nursing home (NH) residents with dementia have limited access to specialty palliative care beyond Medicare hospice. Objectives The objective of this study was to examine the value of expanded palliative care access for NH residents with moderate-to-very severe dementia. Methods We merged palliative care consultation data in 31 NHs in two states to Medicare data to identify residents with consultations, moderate-to-very severe dementia, and deaths in 2006-2010. Initial palliative consultations were identified as occurring later and earlier (1-30 days and 31-180 days before death, respectively). Three controls for each consultation recipient were selected using propensity score matching. Weighted multivariate analyses evaluated the effect of consultations on hospital or acute care use seven and 30 days before death and on (potentially) burdensome transitions (i.e., hospital or hospice admission three days before death or two plus acute care transitions 30 days before death). Results With earlier consultation (vs. no consultation), hospitalization rates in the seven days before death were on average 13.2 percentage points lower (95% confidence interval [CI] -21.8%, -4.7%) and with later consultation 5.9 percentage points lower (95% CI -13.7%, +4.9%). For earlier consultations (vs. no consultations), rates were 18.4 percentage points lower (95% CI -28.5%, -8.4%) for hospitalizations and 11.9 lower (95% CI -20.7%, -3.1%) for emergency room visits 30 days before death; they were 20.2 percentage points lower (95% CI -28.5%, -12.0%) for burdensome transitions. Conclusion Consultations appear to reduce acute care use and (potentially) burdensome transitions for dying residents with dementia. Reductions were greater when consultations were earlier.
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APA 7th
Miller, S. C., Lima, J. C., Intrator, O., Martin, E., Bull, J., & Hanson, L. C. (2017). Specialty Palliative Care Consultations for Nursing Home Residents With Dementia. Journal of pain and symptom management. https://doi.org/10.1016/j.jpainsymman.2017.03.005
Vancouver
Miller SC, Lima JC, Intrator O, Martin E, Bull J, Hanson LC. Specialty Palliative Care Consultations for Nursing Home Residents With Dementia. Journal of pain and symptom management. 2017. doi:10.1016/j.jpainsymman.2017.03.005. PMID: 28438589.
BibTeX
@article{miller2017-28438589,
author = {Miller, S. C. and Lima, J. C. and Intrator, O. and Martin, E. and Bull, J. and Hanson, L. C.},
title = {{Specialty Palliative Care Consultations for Nursing Home Residents With Dementia}},
journal = {Journal of pain and symptom management},
year = {2017},
doi = {10.1016/j.jpainsymman.2017.03.005},
pmid = {28438589},
url = {https://doi.org/10.1016/j.jpainsymman.2017.03.005}
}
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Key findings
- Results With earlier consultation (vs. no consultation), hospitalization rates in the seven days before death were on average 13.2 percentage points lower (95% confidence interval [CI] -21.8%, -4.7%) and with later consultation 5.9 percentage points lower (95% CI -13.7%, +4.9%).
Study details
- Effect size21.8%; 4.7%; 13.7%
- Evidence strengthLow
How this study scored 43/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, studied in people and randomized / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record and institution's track record, so those were left out: it earned 26 of the 61 points we could judge it on, which is 43 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of pain and symptom management) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2017 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multicenter collaboration | 2 / 3 | PubMed indexes it as a multicentre study |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 28438589) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 26 / 61 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 26 of the 61 points we could judge it on is 43 out of 100. |
| Total | 43 / 100 | — |
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