Churning Patients Through Care Settings at EOL: An Interview with Shi-Yi Wang
11/08/2017
One-third of the Medicare patients who died in 2011 had 4 or more transitions within last 6 months of life. #HPM https://t.co/jn2x6tLJmg pic.twitter.com/rW55dKhFJE— JAGS (@AGSJournal) April 4, 2017
For the inaugural JAGS GeriPal podcast, we spoke with Shi-Yi Wang, Assistant Professor in the School of Public Health at Yale. Dr. Wang published a JAGS manuscript titled, "End-of-Life Transition Patterns of Medicare Beneficiaries."
In a brilliant accompanying editorial, Joanne Lynn describes the reasons for these transitions: our health care system fails to support the majority of older adults with serious complex medical illness.
Instead, the United States is in the process of implementing ever-more-fragmented service delivery arrangements for Medicare beneficiaries living with progressive, eventually fatal, advanced illnesses and disabilities. Few outpatient physicians manage their hospitalized patients. New specialists in palliative care consult to settle goals of care and advise about symptom management, but they rarely provide ongoing primary care around the clock. Hospice promises to stay with the individual and family through death and bereavement—but hospice serves most enrollees only for 1 or 2 weeks. Hospice programs now often discharge very sick and disabled individuals when they live too long,[8] thereby abrogating the promise of continuity. The Program of All-Inclusive Care of the Elderly (PACE) rarely discharges participants, providing thoroughly comprehensive services to the end of life for elderly persons eligible for Medicaid and living with disabilities, but PACE serves only approximately 38,000 participants nationwide, which is a very small proportion of affected people. Outside of PACE and hospice, very sick and disabled people in their last phase of life usually see many different doctors, often in the emergency department and specialty consultation, without clear or comprehensive care plans and without the support that they and their families need.
Enjoy!
A transcript is available here, for those who prefer to read rather than listen (you're missing out on a hack job of Peaceful Easy Feeling!)
Links:
- Article: Shi-Yi Wang and colleagues End-of-Life Transition Patterns of Medicare Beneficiaries
- Editorial: Joanne Lynn A Moving Target - Medicare Beneficiaries Coming to the End of Long Lives
- TED Talk: Hans Rosling The Best Stats You've Never Seen
Listen to GeriPal Podcasts on:
By: @AlexSmithMD
Produced by: Sean Lang-Brown
