Blog Post | June 21, 2017

Advanced Illnesses Spawn A New Lexicon of Buzzwords and Acronyms


As the challenges mount for payers and providers regarding how to address the issues facing patients with serious illnesses, there is a growing lexicon of buzzwords – the terms and acronyms that are becoming an important part of the discussion.

John Halsey Turn Key Health

John Halsey
VP, Business Development

While it took years for the healthcare marketplace to fully embrace the terms PCMH, PHM, ACO, and dozens of others, this new set of acronyms join the healthcare lexicon  – especially with a growing number of at-risk patients and the associated, escalating costs of care.

Here’s a sampling of some of the new terms that are appearing with regularity – and we’ll be adding many more in the weeks ahead.  As we build this library of terms, please send us your suggestions:  jhalsey@turn-keyhealth.com. You can also subscribe to our blog to receive our latest postings.

 

Palliative Care

Palliative care is specialized care for members with an advanced illness that provides relief from symptoms and stress, medication management, offers care coordination and other support that may have gone missing from traditional models.  The goal is to improve quality of life for both the patient and the family.

Experience shows that effective palliative interventions depend upon meaningful conversations among patients, families, and caregivers that result in shared decision-making that aligns treatment options with personal goals for care.

As palliative care evolves from an end-of-life modality to a population health management strategy, a growing number of payers are introducing these specialized palliative interventions. The sooner this level of care is introduced, the greater the likelihood for improving quality of life, avoiding costly NBT, and averting over-medicalized death for these vulnerable patients.

In fact, a study in the New England Journal of Medicine shows palliative care can also help patients live longer.  In a study of 151 patients with advanced lung cancer, those given early palliative care survived 11.6 months, nearly three months longer than those who received standard medical care.[1]

 

Palliative Extensivist™

A Palliative Extensivists™, such as a specially trained nurses, social workers or other clinicians, extend their scope of practice outside the hospital and into the home or other settings. These community-based, specially trained Palliative Extensivists™ are experts at leading sensitive discussions with patients and families regarding goals of treatment.  They are resources who are available and affordable, allowing payers to increase the scope and frequency of touching individual patient lives and scale their programs for larger populations.

These professionals aim to help people with chronic illness keep patients healthier outside the hospital. The goal is that such regular, routine visits could help keep patients out of the emergency room, avoid hospitalizations or readmissions, and ICU stays.

 

Over-Medicalized Care

Over-medicalized care is unnecessary or unwanted interventions that prolong life but diminish patient/caregiver satisfaction with care, such as more days spent in ICU.

A retrospective analysis of outcomes found that, among more than 1.5 million Medicare recipients, treatment in the ICU – which may involve breathing machines, feeding tubes and arm restraints to prevent accidental dislodgment of the various tubes and catheters[2] — was not associated with a survival advantage in patients hospitalized for acute myocardial infarction, COPD or heart failure exacerbations.[3]

Over-medicalized care includes:

Over-Medicalized Death

This occurs when treatments and technologies are used by default, even when they are unlikely to help the patient. By the time patients are approaching the end, they are often too weak or disabled to express their preferences.[4]

  • Chemotherapy for cancer patients within 14 days of death
  • Unplanned hospitalization within 30 days of death
  • More than one emergency department (ED) visit within 30 days of death
  • ICU admission within 30 days of death; or
  • Life-sustaining treatment within 30 days of death

This occurs when treatments and technologies are used by default, even when they are unlikely to help the patient. By the time patients are approaching the end, they are often too weak or disabled to express their preferences.

In fact, 80 percent of Americans would prefer to die at home, but only 20 percent achieve this wish.[5]

Inappropriate Death

An inappropriate death is the result of care that did not benefit the patient as a whole.

Advanced medical technology has created uncertainty about what interventions are appropriate or potentially beneficial for members with advanced illness. This includes technologies such as dialysis, mechanical ventilation, ventricular assist devices, and parenteral nutrition which make it possible to sustain life.

Given the risk of NBT, however, healthcare providers must balance the potential benefits of medical treatment against the effects on quality of life for the individual, and whether such treatment is consistent with the patient’s personal values and beliefs.[6] 

Non-Beneficial Treatment (NBT)

NBT refers to the overtreatment of patients with advanced illnesses, as described in the terms Over-medicalized Care, Over-medicalized Death, and Inappropriate Death.

It is broadly defined as any treatment, procedure or test administered to patients who are naturally dying that will not make a difference to their survival, will probably impair their remaining quality of life, can potentially cause them pain or prolonged suffering, or leave them in a worse state of health than they were.[7]

NBT may prolong life, but at a high cost in terms of social and economic burdens that translate into significant strains on members and their families. These individuals often suffer through unnecessary, even harmful treatments despite overriding expert opinion that, when patients have a terminal illness, at some point more disease treatment does not equal better care.

 

Growing interest in the issues surrounding advanced illness will likely spawn an even more extensive set of terms.  Stay tuned to our Turn-Key Health Blog posts and we will be including suggestions from the marketplace.


[1] Jennifer S. M.D., et. al; Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer; New England Journal of Medicine;.http://www.nejm.org/doi/pdf/10.1056/NEJMoa1000678

[2] Zitter, Jessica Nutik; First, Sex Ed. Then Death Ed.; New York Times; Feb. 18, 2017; https://mobile.nytimes.com/2017/02/18/opinion/sunday/first-sex-ed-then-death-ed.html?smid=tw-share&_r=0&referer=https://t.co/tPDvjLekFD; accessed February 21, 2017.

[3] http://www.medpagetoday.com/criticalcare/generalcriticalcare/63240; accessed March 13, 2017.

[4] Duncan, Ian; 2016 Society of Actuaries presentation; https://www.soa.org/Files/Pd/2016/health-meeting/pd-2016-06-health-session-58.pdf

[5] Zitter, 2017.

[6] Miller-Smith, Laura & Lantos, John D.; Palliative care: Medically futile and potentially inappropriate/inadvisable therapies; Up to Date; April 1, 2016; http://www.uptodate.com/contents/palliative-care-medically-futile-and-potentially-inappropriate-inadvisable-therapies; accessed March 13, 2017.

[7] Cardona-Morrell, Magnolia et al; Non-beneficial treatment at the end of life; UNSW; 2016; https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0007/327580/Magnolia_Cardona-Morrell_Presentation_ED_Leadership_Forum_5_August_2016.pdf; accessed March 1, 2017.


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