ArticleThe American journal of managed care2025
Clinician-identified health characteristics and palliative care eligibility: is dementia overlooked?
Article in The American journal of managed care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesCommunity-based palliative care provides support for community-dwelling individuals with elevated mortality risk, including those with dementia, who are underserved by palliative care. However, clinicians' eligibility assessment processes are not well understood. This study evaluates the relationship between the factors that clinicians indicate are important and the eligibility determinations for a community-based palliative care program. STUDY
designRetrospective cohort analysis of July 2022 to December 2023 Medicare administrative claims data for a Medicare Advantage plan offering community-based palliative care. Participants included all members of the Medicare Advantage insurance plan who were identified as being at elevated risk for mortality and evaluated for palliative care need.
methodsMultivariate logistic regression examined the relationship between eligibility determinations for a community-based palliative care program (outcome) and 4 factors that palliative care team members identify as important for determining palliative care need: diagnoses, symptom management, functional ability, and health care utilization.
resultsOf 343 palliative care evaluations (for 322 unique patients), 38% were of patients who identified as African American/Black, 38% as White, 9% as Asian/Pacific Islander, and 15% as other races; 41% were of patients who identified as Hispanic/Latino (measured separately from race); 80% were of female patients; and the mean patient age was 88 years. Of these, 169 (49%) evaluations were for patients who were eligible for palliative care. In multivariate logistic regression analysis of the factors team members deemed important when determining eligibility, only dementia was significantly associated-and negatively-with the final eligibility decision (adjusted OR, 0.45; 95% CI, 0.26-0.75; P = .003).
conclusionsThere is a potential mismatch between what clinicians identify as important in determining palliative care need and final eligibility determinations. Patients with dementia were less likely to be referred for palliative care despite elevated risk of mortality, indicating a potential missed opportunity.
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