A High-Touch Model of Community-Based Specialist Palliative Care: Latent Class Analysis Identifies Distinct Patient Subgroups

Lara Dhingra, Nathan Dieckmann, Helena Knotkova, Jack Chen, Alexa Riggs, Brenda Breuer, Barbara Hiney, Bernard Lee, Maureen McCarthy, Russell Portenoy

    Research output: Contribution to journalArticle

    7 Citations (Scopus)

    Abstract

    Context Community-based palliative care may support seriously ill homebound patients. Programs vary widely, and few studies have described the heterogeneity of the populations served or service delivery models. Objectives To evaluate a diverse population served by an interdisciplinary model of community-based specialist palliative care and the variation in service delivery over time and identify subgroups with distinct illness burden profiles. Methods A retrospective cohort study evaluated longitudinal electronic health record data from 894 patients served during 2010–2013. Illness burden was defined by measures of performance status (Karnofsky Performance Status scale), symptom distress (Condensed Memorial Symptom Assessment Scale), palliative care needs (Palliative Outcome Scale), and quality of life (Spitzer Quality of Life Index). Service utilization included the frequency of visits received and calls made or received by patients. Latent class analysis identified patient subgroups with distinct illness burden profiles, and mixed-effects modeling was used to evaluate associations between patient characteristics and service utilization. Results The mean age was 72.3 years (SD = 14.0); 56.2% were women; 67.5% were English speaking; and 22.2% were Spanish speaking. Most had congestive heart failure (36.4%) or cancer (30.4%); 98.0% had a Karnofsky Performance Status score of 40–70. Four patient subgroups were identified: very low illness burden (26.2%); low burden (39.5%); moderate burden (13.5%); and high burden (20.8%). The subgroups differed in both baseline characteristics and palliative care service utilization over time. Conclusion The population served by a community-based specialist palliative care program manages patients with different levels of illness burden, which are associated with patient characteristics and service utilization.

    Original languageEnglish (US)
    Pages (from-to)272-283
    Number of pages12
    JournalJournal of Pain and Symptom Management
    Volume52
    Issue number2
    DOIs
    StatePublished - Aug 1 2016

    Fingerprint

    Touch
    Palliative Care
    Cost of Illness
    Karnofsky Performance Status
    Quality of Life
    Heart Neoplasms
    Symptom Assessment
    Electronic Health Records
    Population Characteristics
    Population
    Cohort Studies
    Heart Failure
    Retrospective Studies

    Keywords

    • Community-based palliative care
    • health services utilization
    • illness burden
    • interdisciplinary care models
    • latent class analysis
    • specialist care

    ASJC Scopus subject areas

    • Nursing(all)
    • Medicine(all)
    • Clinical Neurology
    • Anesthesiology and Pain Medicine

    Cite this

    A High-Touch Model of Community-Based Specialist Palliative Care : Latent Class Analysis Identifies Distinct Patient Subgroups. / Dhingra, Lara; Dieckmann, Nathan; Knotkova, Helena; Chen, Jack; Riggs, Alexa; Breuer, Brenda; Hiney, Barbara; Lee, Bernard; McCarthy, Maureen; Portenoy, Russell.

    In: Journal of Pain and Symptom Management, Vol. 52, No. 2, 01.08.2016, p. 272-283.

    Research output: Contribution to journalArticle

    Dhingra, Lara ; Dieckmann, Nathan ; Knotkova, Helena ; Chen, Jack ; Riggs, Alexa ; Breuer, Brenda ; Hiney, Barbara ; Lee, Bernard ; McCarthy, Maureen ; Portenoy, Russell. / A High-Touch Model of Community-Based Specialist Palliative Care : Latent Class Analysis Identifies Distinct Patient Subgroups. In: Journal of Pain and Symptom Management. 2016 ; Vol. 52, No. 2. pp. 272-283.
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    abstract = "Context Community-based palliative care may support seriously ill homebound patients. Programs vary widely, and few studies have described the heterogeneity of the populations served or service delivery models. Objectives To evaluate a diverse population served by an interdisciplinary model of community-based specialist palliative care and the variation in service delivery over time and identify subgroups with distinct illness burden profiles. Methods A retrospective cohort study evaluated longitudinal electronic health record data from 894 patients served during 2010–2013. Illness burden was defined by measures of performance status (Karnofsky Performance Status scale), symptom distress (Condensed Memorial Symptom Assessment Scale), palliative care needs (Palliative Outcome Scale), and quality of life (Spitzer Quality of Life Index). Service utilization included the frequency of visits received and calls made or received by patients. Latent class analysis identified patient subgroups with distinct illness burden profiles, and mixed-effects modeling was used to evaluate associations between patient characteristics and service utilization. Results The mean age was 72.3 years (SD = 14.0); 56.2{\%} were women; 67.5{\%} were English speaking; and 22.2{\%} were Spanish speaking. Most had congestive heart failure (36.4{\%}) or cancer (30.4{\%}); 98.0{\%} had a Karnofsky Performance Status score of 40–70. Four patient subgroups were identified: very low illness burden (26.2{\%}); low burden (39.5{\%}); moderate burden (13.5{\%}); and high burden (20.8{\%}). The subgroups differed in both baseline characteristics and palliative care service utilization over time. Conclusion The population served by a community-based specialist palliative care program manages patients with different levels of illness burden, which are associated with patient characteristics and service utilization.",
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    AU - Knotkova, Helena

    AU - Chen, Jack

    AU - Riggs, Alexa

    AU - Breuer, Brenda

    AU - Hiney, Barbara

    AU - Lee, Bernard

    AU - McCarthy, Maureen

    AU - Portenoy, Russell

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    N2 - Context Community-based palliative care may support seriously ill homebound patients. Programs vary widely, and few studies have described the heterogeneity of the populations served or service delivery models. Objectives To evaluate a diverse population served by an interdisciplinary model of community-based specialist palliative care and the variation in service delivery over time and identify subgroups with distinct illness burden profiles. Methods A retrospective cohort study evaluated longitudinal electronic health record data from 894 patients served during 2010–2013. Illness burden was defined by measures of performance status (Karnofsky Performance Status scale), symptom distress (Condensed Memorial Symptom Assessment Scale), palliative care needs (Palliative Outcome Scale), and quality of life (Spitzer Quality of Life Index). Service utilization included the frequency of visits received and calls made or received by patients. Latent class analysis identified patient subgroups with distinct illness burden profiles, and mixed-effects modeling was used to evaluate associations between patient characteristics and service utilization. Results The mean age was 72.3 years (SD = 14.0); 56.2% were women; 67.5% were English speaking; and 22.2% were Spanish speaking. Most had congestive heart failure (36.4%) or cancer (30.4%); 98.0% had a Karnofsky Performance Status score of 40–70. Four patient subgroups were identified: very low illness burden (26.2%); low burden (39.5%); moderate burden (13.5%); and high burden (20.8%). The subgroups differed in both baseline characteristics and palliative care service utilization over time. Conclusion The population served by a community-based specialist palliative care program manages patients with different levels of illness burden, which are associated with patient characteristics and service utilization.

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