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1.
Tradition ; 35(1): 98-103, 2001.
Article in English | MEDLINE | ID: mdl-12569944

Subject(s)
Hospice Care , Judaism , Humans
2.
J Palliat Med ; 1(2): 127-37, 1998.
Article in English | MEDLINE | ID: mdl-15859888
4.
Hosp J ; 12(2): 49-55, 1997.
Article in English | MEDLINE | ID: mdl-9248397

ABSTRACT

As the concept of hospice has evolved in the United States, it has become apparent that there is a significant need for increased physician participation in all aspects of the care of terminally ill patients provided by hospice programs. Four distinct physician roles have emerged: the attending physician, the consulting physician, the hospice medical director, and the hospice team physician. As the roles of the hospice medical director and team physician have become better defined, many physicians are finding that palliative medicine and full time hospice employment is a rewarding career option. The increased involvement of physicians in all aspects of hospice and palliative care will result in measurable improvement in the quality of patient care that hospice programs provide to terminally ill patients and families.


Subject(s)
Hospice Care/organization & administration , Job Description , Physician's Role , Humans , Quality of Health Care
5.
Am J Hosp Palliat Care ; 13(6): 38-44, 1996.
Article in English | MEDLINE | ID: mdl-8945102

ABSTRACT

OBJECTIVE: To determine whether the diagnosis "debility, unspecified" (ICD-9 code 799.3) is appropriate for use with terminally ill patients and to define the criteria for assigning the diagnosis. DESIGN: A survey of patient charts to determine the clinical characteristics of a defined cohort. SETTING: A comprehensive hospice program with average daily census over 500 patients. PATIENTS: All patients who died in the hospice program during the period from January through October, 1993 and were assigned a diagnosis of "debility, unspecified" (ICD-9, 799.3). MEASUREMENTS: For each patient, the following information was recorded: demographics, level of function (ability to carry out activities of daily living), presence of major system disease, other illnesses, any other appropriate ICD-9 coded diagnosis. RESULTS: The diagnosis of "debility, unspecified" was confirmed in 50 out of 53 cases. All 50 patients exhibited multiple comorbid conditions. Major organ system impairment included central nervous system (96 percent of patients), cardiopulmonary (76 percent of patients), skin integrity (42 percent of patients), and sepsis at the time of admission (30 percent of patients). The average survival for these patients was 67 days and the median survival was 20 days. In none of the 50 patients was there a single major system impairment of a degree to warrant a specific terminal diagnosis. CONCLUSIONS: The use of the ICD-9 code 799.3 "debility, unspecified" as a terminal diagnosis was confirmed to be appropriate based on survival and hospice length of stay data and on the fact that no patients exhibited a singular major system disease sufficient to support a terminal prognosis. A decision tree for assigning the diagnosis is presented.


Subject(s)
Diagnosis-Related Groups , Frail Elderly , Activities of Daily Living , Aged , Comorbidity , Decision Trees , Female , Geriatric Assessment , Hospice Care , Humans , Length of Stay , Male , Reproducibility of Results , Survival Analysis , Survival Rate
6.
Support Care Cancer ; 3(1): 28-36, 1995 Jan.
Article in English | MEDLINE | ID: mdl-7535167

ABSTRACT

In order to understand some of the ethical dilemmas that face hospice programs in the United States, one must understand the Medicare Hospice Benefit, which is the model by which hospice programs provide palliative care to terminally ill patients in the United States. Unlike palliative care programs outside the United States, patients must have a prognosis of 6 months or less to receive hospice care under the Medicare Hospice Benefit. Care is reimbursed on a per diem basis, and inpatient care is restricted to pain and symptom management that cannot be managed in another setting. Ethical dilemmas that face physicians referring patients to hospice programs include the ability of clinicians to predict accurately a patient prognosis of 6 months or less, and to what extent hospice programs and clinicians are obligated to provide patients with full information about their illness, as the Medicare Hospice Benefit requires that patients sign an informed consent in order to elect the hospice benefit. There are ethical dilemmas that affect day-to-day patient management in palliative care programs including physician concern over the use of morphine because of possible respiratory depression in the advanced cancer patient, the question of providing enteral or parenteral nutritional support to patients who refuse to eat near the end of life, and the question of providing parenteral fluids to patients who are unable to take fluids during the terminal phases of illness. A final ethical dilemma concerns the methodology for quality of life research in palliative care. By following current research dogma, and only considering patient-generated data as valid, the patient population that most needs to be studied is excluded. A new methodology specifically for palliative care research is needed to provide information on the patients who are cognitively or physically impaired and unable to provide input regarding their needs near the end of life.


Subject(s)
Ethics, Medical , Hospices/standards , Neoplasms/therapy , Palliative Care/standards , Bioethical Issues , Cultural Diversity , Double Effect Principle , Ethics , Federal Government , Government Regulation , Home Care Services , Hospices/legislation & jurisprudence , Humans , Informed Consent , Intention , Medicare/standards , Morphine/administration & dosage , Nutritional Support , Palliative Care/methods , Palliative Care/trends , Patient Selection , Prognosis , Quality of Life , Research Subjects , United States
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