Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
J Pain Symptom Manage. 2019 Jan;57(1):100-107. doi: 10.1016/j.jpainsymman.2018.09.023. Epub 2018 Oct 11.
In 2013, the Centers for Medicare and Medicaid Services issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team before surgery. Subsequently, many VAD programs implemented a mandatory preimplantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults.
All patients undergoing DT VAD implantation at Northwestern Memorial Hospital from October 30, 2013 (the Centers for Medicare and Medicaid Services decision date), through March 1, 2018, were included. Palliative care consultation notes were qualitatively analyzed for elements of "palliative care assessment" and preparedness planning.
Sixty-eight preimplantation palliative care consultations were analyzed. Fifty-six percent of the consults occurred in the intensive care unit, and the median time from consult to VAD implant was six days. General palliative care elements were infrequently discussed. Furthermore, the elements of preparedness planning-device failure, post-VAD health-related quality of life, device complications, and progressive comorbidities-were discussed in only 10%, 54%, 49%, and 12% of consultations, respectively.
One-time preimplantation palliative care consultations at our institution do not lead to completion of preparedness planning or even general palliative care assessment. Further work is needed to determine the most effective way to integrate palliative care into preimplantation care.
2013 年，医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）发布了一项规定，要求所有接受心脏移植辅助设备（destination therapy ventricular assist device，DT VAD）植入术的患者在手术前都可以获得姑息治疗团队的服务。此后，许多 VAD 项目为考虑 DT VAD 的患者实施了强制性的植入前姑息治疗咨询。然而，对于这些咨询的质量知之甚少。
纳入 2013 年 10 月 30 日（医疗保险和医疗补助服务中心决定日期）至 2018 年 3 月 1 日期间在西北纪念医院接受 DT VAD 植入术的所有患者。对姑息治疗咨询记录进行定性分析，以了解姑息治疗评估和准备计划的内容。
分析了 68 次植入前姑息治疗咨询。56%的咨询发生在重症监护病房，从咨询到 VAD 植入的中位时间为 6 天。一般姑息治疗内容很少被讨论。此外，准备计划的内容——设备故障、VAD 植入后的健康相关生活质量、设备并发症和进行性合并症——仅在 10%、54%、49%和 12%的咨询中被讨论。
我们机构的一次性植入前姑息治疗咨询并没有导致准备计划的完成，甚至没有导致一般姑息治疗评估的完成。需要进一步努力确定将姑息治疗纳入植入前护理的最有效方法。
