Literature Review

How Houston Methodist’s ACO reduced its end-of-life spending by nearly 20% MedCity News - Hospitals; by Katie Adams; March 10, 2025 Houston Methodist Coordinate Care is reducing costs through a partnership with Koda Health, a digital platform that guides patients through their end-of-life choices. Preliminary findings show the technology resulted in a 19% reduction in the total cost of care for patients at the end of their life, which equals nearly $9,000 in savings per patient. ... The ACO has been working with Koda Health for more than three years — and it is saving money by getting patients more involved in their end-of-life care plan.

Algorithm-based palliative care in patients with cancer-A cluster randomized clinical trialJAMA Network Open; Ravi B. Parikh, MD, MPP; William J. Ferrell, MPH; Yang Li, MS; Jinbo Chen, PhD; Larry Bilbrey; Nicole Johnson, BSN; Jenna White, MSW; Ramy Sedhom, MD; Natalie R. Dickson, MD; Stephen Schleicher, MD; Justin E. Bekelman, MD; Sandhya Mudumbi, MD; 2/25In this randomized clinical trial conducted in a community oncology network between November 2022 and December 2023 among 562 patients with advanced cancer identified by an automated electronic health record algorithm, default orders increased palliative care consultation (44% vs 8%) and decreased end-of-life systemic therapy (6% vs 16%) compared with usual care but did not improve patient-reported or hospice outcomes. The findings suggest that default algorithm-based palliative care orders are a scalable implementation strategy to increase palliative care referrals and reduce intensive end-of-life care. 

Lending a helping harp: Music therapist Sarah Ohr uses the power of music in hospice care VolumeOne - Theme Issue "Death & Taxes"; by Barbara Arnold; 3/6/25... Dubbed the "hospice harpist," Sarah is a harpist and more. Music has been part of her life since a child growing up in Green Bay, where her parents adopted Sarah and her adopted brother Steve separately from South Korea.  ... “Harp and piano are my musical loves,” Sarah noted in an interview. ... Two events, which both occurred in early April 2018, served as life-changing catalysts for Sarah: her brother, Steve, was murdered in Chicago, and Sarah received a cancer diagnosis that would require major surgery. ... [Click on the title's link to read Sarah's career journey as a performer and into music therapy.] ... [Now, Sarah serves St. Croix Hospice in Eau Claire, WI as a board certified music therapist.] According to Sarah, there is a perception that a patient can request her to entertain them. In reality, in order for Sarah to offer support to a patient, medical necessity must be present. “First, I need to be called in as part of the care team, ... Next, I meet with the patient or the patient’s family to conduct an assessment. In super simple terms: is there social isolation, depression, anxiety, pain management, or a neurological reason, by which music can fulfill a need?"Editor's note: Find professional music therapists at the Certification Board for Music Therapists.

The rising importance of social workers on the home health team Home Health Care News; by Audrie Martin; 3/10/25 Addressing social determinants of health (SDoH) is becoming increasingly important due to new regulations from the Centers for Medicare & Medicaid Services (CMS) and the shift toward value-based care payment models. With ongoing staffing shortages and a growing demand for home-based care services, social workers are taking on greater responsibilities to support the health care system. ... Individuals requiring home health care often need complex support that addresses both their medical and psychosocial needs, especially if they are isolated from typical social interactions and services. Some home care teams are now integrating home health social workers (HHCSWs) to provide a comprehensive approach to care that considers these SDoHs.Editor's note: March is National Social Work Month. Click here for National Association of Social Worker's (NASW) Social Media Toolkit for Social Work 2025.

Sunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!

My wrinkles show I laughed,My gray hair shows I cared,My scars show I lived, andMy belly shows I really like snacks.

[Canada] Use of feeding tubes among hospitalized older adults with dementiaJAMA Network Open; Anne-Marie Hartford, MSc; Wenshan Li, PhD; Danial Qureshi, MSc; Robert Talarico, MSc; Stephen G. Fung, MPH; Shirley H. Bush, MBBS; Genevieve Casey, MSc, MBBS; Sarina R. Isenberg, MA, PhD; Colleen Webber, PhD; Peter Tanuseputro, MHSc, MD; 2/25In this cohort study of hospitalized individuals with dementia, feeding tube insertion was not associated with improved survival or postdischarge outcomes. Being male or younger and having swallowing problems and greater functional impairments were associated with increased odds of feeding tube use, while having a do-not-resuscitate directive and living in rural settings were associated with reduced odds. Factors that were (or were not) associated with feeding tube placement were sometimes misaligned with best practice guidelines. Goals of care conversations, alternative intervention options, and improved clinical protocols are recommended. 

Researcher proposes new framework for language equity in health technologyJAMA; Yulin Hswen, ScD, MPH; Nora Collins; 2/25In a recent Editorial in JAMA Network Open, Pilar Ortega, MD, MGM, a clinical associate professor of medical education and emergency medicine at the University of Illinois College of Medicine in Chicago, and her coauthors emphasized the urgent need for integrating language equity into digital health solutions. “Technology may enhance health equity, but only if marginalized populations’ perspectives and root causes of health disparities are considered across key aspects of health care provision and at every stage of project development: design, evaluation, implementation, and revision,” they wrote. There are [more than] 350 languages spoken in the US. We need to do things that on a system level make it possible for individuals of any language preference to not only access care but that the health care quality they receive is comparable and equitable, so they can be enrolled in clinical trials [and] access all the different levels of care they might need. 

Psychedelics for cancer pain and associated psychological distress: A narrative review of a potential strategyCancer Medicine; Erika Belitzky, Lis Victoria Ravani Carvalho, Melissa Taylor, Cristina Naranjo Ortiz, Laura Baum, David A Fiellin, Maryam B Lustberg; 3/25Cancer pain can ... be exacerbated by anxiety, depression, quality of life challenges, and fear of death and dying, as well as by fear of recurrence or progression. Psychedelics, such as lysergic acid diethylamide (LSD), psilocybin, mescaline, and N,N-dimethyltryptamine (DMT), are under consideration as new pharmacologic strategies for mitigating pain and the distress associated with cancer pain and associated symptom burden. Although published studies are limited, regulatory hurdles have decreased. Many clinical trials are underway to assess further the use of psychedelics and behavioral counseling for patients with cancer and comorbidities such as anxiety or depression. Early results are promising, and additional research is needed to understand efficacy and tolerability in broader cancer populations. 

The preference for acute rehospitalization scale: Evaluating preference for acute rehospitalization in pediatric hospice patientsJournal of Palliative Medicine; Kelley Newcomer, Katherine Maddox; 3/25Since the passage of the Affordable Care Act, children are able to access pediatric hospice while still pursuing life-prolonging care. This can create confusion between hospice and palliative care staff and families about current goals of care (GOC), which evolve over time. Hospice and palliative care teams created, implemented, and evaluated a five-point scale to summarize the Preference for Acute Rehospitalization (PAR) Scale for children on concurrent care hospice. Most users reported they agreed or strongly agreed the PAR Scale helped them to understand families' GOC and feel more confident giving advice with urgent questions.

Hospice use among Medicare beneficiaries with Parkinson Disease and Dementia with Lewy bodiesJAMA Network Open; Meredith Bock, MD; Siqi Gan, MPH; Melissa Aldridge, PhD; Krista L. Harrison, PhD; Kristine Yaffe, MD; Alexander K. Smith, MD; John Boscardin, PhD; Lauren J. Hunt, PhD; 3/25Lewy body disease (LBD)—an umbrella term that includes Parkinson disease (PD) and dementia with Lewy bodies (DLB)—describes progressive, incurable neurodegenerative disorders. Parkinson disease is the second most common neurodegenerative disorder after Alzheimer disease (AD) and is the fastest growing neurologic disorder in the world.In this cohort study of ... Medicare beneficiaries enrolled in hospice between 2010 and 2020, hospice enrollees with both PD and DLB were less likely to be disenrolled due to extended prognosis than those with AD. Enrollees with PD—but not DLB–were more likely to have longer lengths of stay and revoke hospice. The findings of this study suggest a higher likelihood of revocation of hospice care in PD, raise important questions about their unmet needs in hospice, and highlight the need to disaggregate dementia subtypes for policy analysis. 

The analysis of hospice trends in the United States in 2020 among Medicare beneficiariesAmerican Journal of Hospice and Palliative Medicine; Noor Chughtai, BS; Cortland Brown, MS; Jordan Shelestak, MS; Jared Nichols, DO; 3/25 While hospice care has many benefits, there is variability among the service throughout the United States. Public hospice care data from data.cms.gov were analyzed to explore these trends. Findings indicate that Medicare beneficiaries in the South and West regions of the U.S. experience longer hospice stays, and in contrast, those in the Northeast and Midwest (including Alaska) reflected reduction from this average. Notably, states with shorter hospice durations showed a higher proportion of neoplastic disorders as the primary diagnosis, while those with longer stays showed an inverse relationship with greater prevalence of circulatory system disorders and lower incidence of neoplastic diagnoses. Additionally, the analysis reveals a consistent decline in average hospice length with increasing age among patients aged 80-85 across all U.S. regions, as expected.

Hospice industry gets reprieve as Trump admin pauses oversight program Axios; by Maya Goldman; 3/13/25 A federal effort to increase oversight of hospice care has been put on hold by the Trump administration, resetting efforts to root out fraud and abuse in an industry that receives more than $25 billion from Medicare annually. Why it matters: Federal officials in recent years have ramped up efforts to identify instances in which hospice operators fraudulently bill the government or enroll patients who aren't terminally ill. But the new administration last month halted a Biden-era plan for noncompliant hospices to take corrective action or risk being kicked out of Medicare. The big picture: Medicare is required by law to implement some version of the targeted oversight program. But it's not clear how that will evolve in President Trump's second term.