Early Impacts of COVID-19 on Select Hospices: Operations, Care Delivery, and Service Utilization.

Objective: The COVID-19 public health emergency (PHE) has important implications for health care service delivery. Little is understood about how the PHE impacted community-based hospice providers and service delivery to hospice-eligible beneficiaries. The aim of this study was to describe hospice response to the PHE and correlated impacts on beneficiary receipt of hospice support services delivered to hospice-eligible beneficiaries participating in the Centers for Medicare & Medicaid Services (CMS) Medicare Care Choices Model (MCCM), a national model testing the provision of certain hospice-like supportive services with concurrent usual care among seriously ill, community-residing Medicare beneficiaries that have not elected to receive hospice care.

Regulation of provider networks in response to COVID-19.

In public health insurance programs, federal and state regulators use network adequacy standards to ensure that health plans provide enrollees with adequate access to care. These standards are based on provider availability, anticipated enrollment, and patterns of care delivery. We anticipate that the coronavirus disease 2019 pandemic will have 3 main effects on provider networks and their regulation: enrollment changes, changes to the provider landscape, and changes to care delivery.

The SCAN Foundation's framework for advancing integrated person-centered care.

A genuine opportunity exists to reform medical and long-term care systems to be more responsive to people's needs and preferences and provide efficient, cost-effective care delivery. California is preparing to test models of integration for those dually eligible for Medicare and Medicaid that aim to improve care while managing costs. The SCAN Foundation has created a conceptual framework for guiding investments in California and beyond that is intended to create a more "person-centered" system that integrates medical care and supportive services.

Prescription sharing, alcohol use, and street drug use to manage pain among veterans.

Context: Efforts to promote awareness and management of chronic pain have been accompanied by a troubling increase in prescription medication abuse. At the same time, some patients may misuse substances in an effort to manage chronic pain.

Objectives: This study examines self-reported substance misuse for pain management among veterans and identifies the contributing factors.

Developing medical record-based performance indicators to measure the quality of mental healthcare.

Recent attention has focused on validity and feasibility of different approaches to developing performance indicators for the purposes of quality improvement and value-based purchasing. This paper presents the methodology used to develop a comprehensive set of performance indicators that will be used for a national evaluation of the mental healthcare provided by the Veterans Health Administration. The paper report on the indicators' technical specifications and the United States Public Health System Task Force defined strength of supporting evidence.

Factors associated with clinician intention to address diverse aspects of pain in seriously ill outpatients.

Background: Pain is a common, often undertreated problem among patients with palliative needs.

Objectives: To evaluate clinician factors associated with intention to address diverse aspects of pain.

Design: Clinicians reviewed a clinical vignette describing a frail elderly patient with advanced hormone-refractory metastatic prostate cancer, depression, and pain not on analgesic therapy.

Nursing staff, patient, and environmental factors associated with accurate pain assessment.

Context: Although pain ranks highly among reasons for seeking care, routine pain assessment is often inaccurate.

Objectives: This study evaluated factors associated with nurses (e.g.

Addressing patients' concerns about pain management and addiction risks.

Fear of engendering addiction is frequently reported as both a provider and a patient barrier to effective pain management. In this study, a clinical scenario ascertained nursing staff members' usual practice in addressing addiction fears for patients with concerns about the addictive potential of pain medication. One hundred forty-five Veterans Health Administration nursing staff members from eight ambulatory care sites were queried to identify variables associated with proclivity to address patient fears about addiction risks in a population where pain is prevalent and the risk for substance abuse is high.

Feasibility of discussing end-of-life care goals with inpatients using a structured, conversational approach: the go wish card game.

Establishing goals of care is important in advance care planning. However, such discussions require a significant time investment on the part of trained personnel and may be overwhelming for the patient. The Go Wish card game was designed to allow patients to consider the importance of common issues at the end of life in a nonconfrontational setting.

Does screening for pain correspond to high quality care for veterans?

Background: Routine numeric screening for pain is widely recommended, but its association with overall quality of pain care is unclear.

Objective: To assess adherence to measures of pain management quality and identify associated patient and provider factors.

Design: A cross-sectional visit-based study.

A framework for assessing quality indicators for cancer care at the end of life.

Patients with advanced cancer often do not receive high-quality pain and symptom management or support with coordination of care, communication, and decision making. Implementing quality indicators that are reflective of the scope of care, feasible to implement, and supported by evidence might help to identify areas and settings most in need of improvement. However, recent reviews and policy initiatives identified only a few indicators that met these criteria.

Heart failure: the hidden problem of pain.

Although dyspnea and fatigue are hallmark symptoms of heart failure (HF), the burden of pain may be underrecognized. This study assessed pain in HF and identified contributing factors. As part of a multicenter study, 96 veterans with HF (96% male, 67+/-11 years) completed measures of symptoms, pain (Brief Pain Inventory [BPI]), functional status (Functional Morbidity Index), and psychological state (Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2).

Demographic and social characteristics and spending at the end of life.

In the United States and abroad, the aging of the population and changes in its demographic and social composition raise important considerations for the future of health care and the systems that pay for care. Studies in the United States on end-of-life expenditures and utilization focus primarily on Medicare and have reported differences in formal end-of-life spending and types of services used by age, race, gender, and other personal characteristics, with most notable differences attributed to age at death. Although overall health care spending tends to be higher for people who are white and women, these patterns tend to either reverse themselves or narrow at the end of life.

Race and sex differences in the receipt of timely and appropriate lung cancer treatment.

Background: Previous research suggests that disparities in non-small-cell lung cancer (NSCLC) survival can be explained in part by disparities in the receipt of cancer treatment. Few studies, however, have considered race and sex disparities in the timing and appropriateness of treatment across stages of diagnosis.

Objective: To evaluate the relationship of sex and race with the receipt of timely and clinically appropriate NSCLC treatment for each stage of diagnosis.

Developing quality indicators for cancer end-of-life care: proceedings from a national symposium.

Quality indicators applicable to cancer end-of-life care exist, but have not been widely implemented. To advance this field, the authors worked with the Agency for Health Care Research and Quality and the National Cancer Institute to organize a national symposium to discuss key issues and future goals, based on a conceptual framework. Discussions focused on 8 key domains in end-of-life cancer care: pain; dyspnea; communication, care planning, and decision making; psychosocial care; communication about chemotherapy; depression; continuity, coordination, and care transitions; and spirituality and closure.

How reliable is pain as the fifth vital sign?

Background: Although many health care organizations require routine pain screening (eg, "5th vital sign") with the 0 to 10 numeric rating scale (NRS), its accuracy has been questioned; here we evaluated its accuracy and potential causes for error.

Methods: We randomly surveyed veterans and reviewed their charts after outpatient encounters at 2 hospitals and 6 affiliated community sites. Using correlation and receiver operating characteristic analysis, we compared the routinely measured "5th vital sign" (nurse-recorded NRS) with a research-administered NRS (research-recorded NRS) and the Brief Pain Inventory (BPI).

Early identification of co-occurring pain, depression and anxiety.

Background: Depression and anxiety frequently co-occur with pain and may affect treatment outcomes. Early identification of these co-occurring psychiatric conditions during routine pain screening may be critical for optimal treatment.

Objective: To determine aspects of pain related to psychological distress, and, among distressed patients, to determine whether pain factors are related to provider identification of distress.

A comparative study of pain in heart failure and non-heart failure veterans.

Background: Progress has been made in addressing pain in specific diseases such as cancer, but less attention has focused on understanding pain in nonmalignant states, including heart failure (HF).

Methods And Results: From March 2006 to June 2007, 672 veterans were surveyed and scores for the Brief Pain Inventory, pain distress, clinically significant pain levels (moderate to severe pain), and pain locations were compared using univariate and multivariate models. Fifteen percent of the final sample had HF (95/634).

Use of postacute care by nursing home residents hospitalized for stroke or hip fracture: how prevalent and to what end?

Objectives: To examine nursing home (NH) residents' use of Medicare-paid skilled nursing facility (SNF) services and the outcomes of that care and to identify clinical and non-clinical factors associated with that care.

Design: Retrospective cohort.

Setting: United States.

Age and gender differences in medicare expenditures and service utilization at the end of life for lung cancer decedents.

Purpose: Gender and age differences in medical care are well documented. We examined age and gender differences in Medicare expenditures for lung cancer decedents in the last year of life (LYOL) through a cross-sectional study of Medicare administrative and claims data.

Methods: Participants were aged Medicare beneficiaries (>or=68) with lung cancer, who were covered by Parts A and B for 36 months before death (1996-1999; n = 13,120).

Evidence for improving palliative care at the end of life: a systematic review.

Background: Many persons and their families are burdened by serious chronic illness in late life. How to best support quality of life is an important consideration for care.

Purpose: To assess evidence about interventions to improve palliative and end-of-life care.

A systematic review of satisfaction with care at the end of life.

The objective of this study was to systematically review the literature to better understand the conceptualization of satisfaction with end-of-life care and the effectiveness of palliative care interventions on this outcome. Data sources included Medline and the Database of Reviews of Effects. The review included relevant qualitative studies and intervention studies using satisfaction as an outcome from 1990 to 2005.

An exploration of urban and rural differences in lung cancer survival among medicare beneficiaries.

Objectives: We tested the relationship between urban or rural residence as defined by rural-urban commuting area codes and risk of mortality in a sample of Medicare beneficiaries with lung cancer.

Methods: We used Surveillance, Epidemiology, and End Results data linked with Medicare claims to build proportional hazards models. The models tested hypothesized relationships between individual and community characteristics and overall survival for a cohort of Medicare beneficiaries 65 years and older who were diagnosed with lung cancer between 1995 and 1999 (N=26073).

A systematic review of measures of end-of-life care and its outcomes.

Objective: To identify psychometrically sound measures of outcomes in end-of-life care and to characterize their use in intervention studies.

Data Sources: English language articles from 1990 to November 2005 describing measures with published psychometric data and intervention studies of end-of-life care.

Study Design: Systematic review of end-of-life care literature.