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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Medical guidelines for determining appropriateness of hospice referral: Non-disease-specific baseline guidelines plus comorbidities

Medical guidelines for determining appropriateness of hospice referral: Non-disease-specific baseline guidelines plus comorbidities

A patient will be considered to have a life expectancy of 6 months or less if they meet the non-disease-specific "Decline in clinical status" guidelines described in Part I. Alternatively, the baseline non-disease-specific guidelines described in Part II plus the applicable disease-specific guidelines (listed in a separate table) will establish the necessary expectancy.

A patient will be considered to have a life expectancy of 6 months or less if there is documented evidence of decline in clinical status that is not considered to be reversible based on the guidelines below.

I. Decline in clinical status guidelines
A. Progression of disease as documented by worsening clinical status, symptoms, signs, and laboratory results
Clinical status:
a. Recurrent or intractable serious infections, such as pneumonia, sepsis, or pyelonephritis
b. Progressive inanition as documented by:
  1. Weight loss of at least 10% body weight in the prior 6 months, not due to reversible causes (eg, depression or use of diuretics)
  2. Decreasing anthropomorphic measurements (mid-arm circumference, abdominal girth), not due to reversible causes (eg, depression or use of diuretics)
  3. Observation of ill-fitting clothes, decrease in skin turgor, increasing skin folds, or other observation of weight loss in a patient without a documented weight
  4. Decreasing serum albumin or cholesterol
  5. Dysphagia leading to recurrent aspiration and/or inadequate oral intake documented by decreasing food portion consumption
Symptoms:
a. Dyspnea with increasing respiratory rate
b. Cough, intractable
c. Nausea/vomiting poorly responsive to treatment
d. Diarrhea, intractable
e. Pain requiring increasing doses of major analgesics more than briefly
Signs:
a. Decline in systolic blood pressure to below 90 or progressive postural hypotension
b. Ascites
c. Venous, arterial, or lymphatic obstruction due to local progression or metastatic disease
d. Edema
e. Pleural/pericardial effusion
f. Weakness
g. Change in level of consciousness
Laboratory (when available; lab testing is not required to establish hospice eligibility):
a. Increasing pCO2 or decreasing pO2 or decreasing SaO2
b. Increasing calcium, creatinine, or liver function studies
c. Increasing tumor markers (eg, CEA, PSA)
d. Progressively decreasing or increasing serum sodium or increasing serum potassium
B. Decline in KPS or PPS due to progression of disease
C. Progressive decline in FAST for dementia (from 7A on the FAST)
D. Progression to dependence on assistance with additional activities of daily living (refer to Part II, below)
E. Progressive stage 3 to 4 pressure ulcers in spite of optimal care
F. History of increasing emergency department visits, hospitalizations, or clinician visits related to the hospice primary diagnosis prior to election of the hospice benefit
II. Non-disease-specific baseline guidelines (both A and B should be met)
A. Physiologic impairment of functional status as demonstrated by KPS or PPS <70%. Note that 2 of the disease-specific guidelines (HIV and stroke/coma) establish a lower qualifying KPS or PPS.
B. Dependence on assistance for 2 or more activities of daily living:
  1. Feeding
  2. Ambulation
  3. Continence
  4. Transfer
  5. Bathing
  6. Dressing
Comorbidities
Although not the primary hospice diagnosis, the presence of comorbid disease that is likely to contribute to a life expectancy of 6 months or less should be considered for hospice eligibility. Comorbid diseases may include:
  1. Chronic obstructive pulmonary disease
  2. Congestive heart failure
  3. Ischemic heart disease
  4. Diabetes mellitus
  5. Neurologic disease (CVA, ALS, MS, Parkinson)
  6. Renal failure
  7. Liver disease
  8. Neoplasia
  9. Acquired immunodeficiency syndrome (AIDS)/HIV
  10. Dementia
  11. Refractory severe autoimmune disease (eg, lupus or rheumatoid arthritis)
A patient will be considered to have a life expectancy of 6 months and be eligible for hospice services if they meet criteria for BOTH the above non-disease-specific baseline guidelines AND disease-specific guidelines (shown on a separate table).
These baseline guidelines do not independently qualify a patient for hospice coverage. Refer to separate table for disease-specific guidelines to be used with these guidelines.
pCO2: partial pressure of carbon dioxide; pO2: partial pressure of oxygen; SaO2: arterial oxygen saturation; CEA: carcinoembryonic antigen; PSA: prostate-specific antigen; KPS: Karnofsky Performance Status; PPS: Palliative Performance Score; FAST: Functional Assessment Staging; HIV: human immunodeficiency virus; CVA: cerebrovascular accident or stroke; ALS: amyotrophic lateral sclerosis; MS: multiple sclerosis.
Reproduced from: Centers for Medicare & Medicaid Services. Local Coverage Determination (LCD) for Hospice Determining Terminal Status (L33393) (Accessed on January 18, 2016).
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