R Sean Morrison

Icahn School of Medicine at Mount Sinai, Borough of Manhattan, New York, United States

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Publications (178)1660.38 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Palliative care is expanding rapidly in the United States. Objective: To examine variation in access to hospital palliative care. Methods: Data were obtained from the American Hospital Association (AHA) Annual Surveys™ for Fiscal Years 2012 and 2013, the National Palliative Care Registry™, the Dartmouth Atlas of Healthcare, the American Census Bureau's American Community Survey (ACS), web searches, and telephone interviews of hospital administrators and program directors. Multivariable logistic regression was used to examine predictors of hospital palliative care programs. Results: Sixty-seven percent of hospitals with 50 or more total facility beds reported a palliative care program. Institutional characteristics were strongly associated with the presence of a hospital palliative care program. Ninety percent of hospitals with 300 beds or more were found to have palliative care programs as compared to 56% of hospitals with fewer than 300 beds. Tax status was also a significant predictor. Not-for-profit hospitals and public hospitals were, respectively, 4.8 times and 7.1 times more likely to have a palliative care program as compared to for-profit hospitals. Palliative care penetration was highest in the New England (88% of hospitals), Pacific (77% of hospitals), and mid-Atlantic (77% of hospitals) states and lowest in the west south central (43% of hospitals) and east south central (42% of hospitals) states. Conclusions: This study demonstrates continued steady growth in the number of hospital palliative care programs in the United States, with almost universal access to services in large U.S. hospitals and academic medical centers. Nevertheless access to palliative care remains uneven and depends on accidents of geography and hospital ownership.
    Journal of palliative medicine 09/2015; DOI:10.1089/jpm.2015.0351 · 1.91 Impact Factor
  • Amy S Kelley · R Sean Morrison
    New England Journal of Medicine 08/2015; 373(8):747-55. DOI:10.1056/NEJMra1404684 · 55.87 Impact Factor
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    ABSTRACT: Previous studies report that early palliative care is associated with clinical benefits, but there is limited evidence on economic impact. This article addresses the research question: Does timing of palliative care have an impact on its effect on cost? Using a prospective, observational design, clinical and cost data were collected for adult patients with an advanced cancer diagnosis admitted to five US hospitals from 2007 to 2011. The sample for economic evaluation was 969 patients; 256 were seen by a palliative care consultation team, and 713 received usual care only. Subsamples were created according to time to consult after admission. Propensity score weights were calculated, matching the treatment and comparison arms specific to each subsample on observed confounders. Generalized linear models with a γ distribution and a log link were applied to estimate the mean treatment effect on cost within subsamples. Earlier consultation is associated with a larger effect on total direct cost. Intervention within 6 days is estimated to reduce costs by -$1,312 (95% CI, -$2,568 to -$56; P = .04) compared with no intervention and intervention within 2 days by -$2,280 (95% CI, -$3,438 to -$1,122; P < .001); these reductions are equivalent to a 14% and a 24% reduction, respectively, in cost of hospital stay. Earlier palliative care consultation during hospital admission is associated with lower cost of hospital stay for patients admitted with an advanced cancer diagnosis. These findings are consistent with a growing body of research on quality and survival suggesting that early palliative care should be more widely implemented. © 2015 by American Society of Clinical Oncology.
    Journal of Clinical Oncology 06/2015; 33(25). DOI:10.1200/JCO.2014.60.2334 · 18.43 Impact Factor
  • R Sean Morrison
    Journal of palliative medicine 04/2015; 18(5). DOI:10.1089/jpm.2015.1026 · 1.91 Impact Factor
  • K. Todd · E. Dickman · U. Hwang · S. Akhtar · R. Morrison
    Journal of Pain 04/2015; 16(4):S68. DOI:10.1016/j.jpain.2015.01.288 · 4.01 Impact Factor
  • Peter May · R. Sean Morrison
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    ABSTRACT: This paper presented provisional results of analyses subsequently published as 'Prospective Cohort Study of Hospital Palliative Care Teams for Inpatients With Advanced Cancer: Earlier Consultation Is Associated With Larger Cost-Saving Effect' in J Clin Oncol (06/2015).
    Journal of Pain and Symptom Management; 02/2015
  • Peter May · R. Sean Morrison
    Journal of Pain and Symptom Management; 02/2015
  • Corita Grudzen · Lynne Richardson · R. Sean Morrison
    Journal of Pain and Symptom Management 02/2015; 49(2):352. DOI:10.1016/j.jpainsymman.2014.11.074 · 2.80 Impact Factor
  • Amy Kelley · Kenneth Covinsky · R. Sean Morrison · Christine Ritchie
    Journal of Pain and Symptom Management 02/2015; 49(2):333. DOI:10.1016/j.jpainsymman.2014.11.035 · 2.80 Impact Factor
  • Journal of Pain and Symptom Management 02/2015; 49(2):342-343. DOI:10.1016/j.jpainsymman.2014.11.054 · 2.80 Impact Factor
  • Katherine Ornstein · Vivian Yeh · Joan Penrod · R. Sean Morrison · Diane Meier
    Journal of Pain and Symptom Management 02/2015; 49(2):381-382. DOI:10.1016/j.jpainsymman.2014.11.132 · 2.80 Impact Factor
  • Journal of Pain and Symptom Management 02/2015; 49(2):369-370. DOI:10.1016/j.jpainsymman.2014.11.108 · 2.80 Impact Factor
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    ABSTRACT: Background The American College of Emergency Physicians and the American Society of Clinical Oncology recommend early palliative care consultation for patients with advanced, life-limiting illnesses, such as metastatic cancer.Objectives The objectives were to assess the process of early referral from the emergency department (ED) to palliative care for patients with advanced, incurable cancer as part of a randomized controlled trial and to compare the proportion and timing of consultation to a care as usual group.MethodsA single-blind randomized controlled trial (ClinicalTrials.gov ID NCT01358110) compared early, ED-based referrals to palliative care for patients admitted with advanced, incurable cancer to physician-driven consultation (i.e., care as usual). Participants had to speak English or Spanish and have no history of palliative care consultation. They were randomized via balanced block randomization to the intervention or control group. Each intervention subject was referred by a research staff member to the palliative care team for consultation. The usual care group received palliative care only if requested by the admitting physician. Analysis was based on intention to treat. A chart review was performed to assess proportion and timing of palliative care consults during the index admission, defined as: 1) completed palliative care consult documented in the chart and 2) days from admission to palliative care consult.ResultsA total of 134 participants were enrolled and randomized. For patients in the intervention group, 88% (60 of 68) had documented palliative care consultations during their index admissions (95% confidence interval [CI] = 80.5 to 95.5), compared to 18% (12 of 66) in the control group (95% CI = 8.8 to 27.5; p < 0.01). The 60 intervention patients received palliative care consultations on average 1.48 days from admission (95% CI = 1.19 to 1.76), compared to 2.9 days from admission in the 12 control patients (95% CI = 1.03 to 4.79; p = 0.15).Conclusions This study documented a low baseline rate of palliative care involvement as part of usual care in patients with advanced cancer being admitted from the ED. Early referral to palliative care in the context of a research study significantly increased the likelihood that patients received a consult, thus meriting further investigation of how to generalize this approach.
    Academic Emergency Medicine 01/2015; 22(2). DOI:10.1111/acem.12573 · 2.01 Impact Factor
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    ABSTRACT: Family satisfaction is an important and commonly used research measure. Yet current measures of family satisfaction are lengthy and may be unnecessarily burdensome - particularly in the setting of serious illness. To use an item bank to develop short-forms of the FAMCARE scale, which measures family satisfaction with care. To shorten the existing 20-item FAMCARE measure, item response theory parameters from an item bank were used to select the most informative items. The psychometric properties of the new short-form scales were examined. The item bank was based on data from family members from an ethnically diverse sample of 1983 patients with advanced cancer. Evidence for the new short-form scales supported essential unidimensionality. Reliability estimates from several methods were relatively high, ranging from 0.84 for the five-item scale to 0.94 for the 10-item scale across different age, gender, education, ethnic and relationship groups. The FAMCARE-10 and FAMCARE-5 short-form scales evidenced high reliability across sociodemographic subgroups, and are potentially less burdensome and time-consuming scales for monitoring family satisfaction among seriously ill patients. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
    Journal of Pain and Symptom Management 12/2014; 49(5). DOI:10.1016/j.jpainsymman.2014.10.017 · 2.80 Impact Factor
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    ABSTRACT: Pain is highly prevalent in healthcare settings, however disparities continue to exist in pain care treatment. Few studies have investigated if differences exist based on patient related characteristics associated with aging. The objective of this study was to determine if there are differences in acute pain care for older versus younger patients. This was a multicenter, retrospective, cross-sectional observation study of 5 emergency departments across the US evaluating the 2 most commonly presenting pain conditions for older adults - abdominal and fracture pain. Multivariable adjusted hierarchical modeling was completed. A total of 6,948 visits were reviewed. Older (⩾65 years) and oldest (⩾85 years) were less likely to receive analgesics when compared to younger patients (<65 years), yet older patients had greater reductions in final pain scores. When evaluating pain treatment and final pain scores, differences appeared to be based on type of pain. Older abdominal pain patients were less likely to receive pain medications, while older fracture patients were more likely to receive analgesics and opioids when compared to younger patients. Differences in pain care for older patients appear to be driven by type of presenting pain.
    Pain 09/2014; 155(12). DOI:10.1016/j.pain.2014.09.017 · 5.21 Impact Factor
  • Peter May · R. Sean Morrison · Charles Normand
    iHEA/ECHE Joint Congress, Trinity College Dublin, Ireland; 07/2014
  • Peter May · Charles Normand · R Sean Morrison
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    ABSTRACT: Abstract Background: Maintaining the recent expansion of palliative care access in the United States is a recognized public health concern. Economic evaluation is essential to validate current provision and assess the case for new programs. Previous economic reviews in palliative care reported on programs across settings and systems; none has examined specifically the hospital consultative model, the dominant model of provision in the United States. Objectives: To review systematically the economic evidence on specialist palliative care consultation teams in the hospital setting, to appraise this evidence critically, and to identify areas for future research in this field. Data Sources: A meta-review ("a review of existing reviews") was conducted of eight published systematic reviews and one relevant nonsystematic review. To identify articles published outside of the timeframe of these reviews, systematic searches were performed on the PubMed, CINAHL, and EconLit databases. Study Selection: Articles were included if they compared the costs and/or cost effectiveness of a specialist hospital inpatient palliative care consultation for adult patients with those of a comparator. Results: Ten studies were included and these demonstrate a clear pattern of cost-saving impact from inpatient consultation programs. Nevertheless, knowledge gaps still exist regarding the economic effects of these programs. Current evidence has been generated from the hospital perspective; health system costs, patient and caregiver costs, and health outcomes are typically not included. Conclusions: Inpatient palliative care consultation programs have been shown to save hospitals money and to provide improved care to patients with serious illness. With a clear pattern of cost-saving using current methodology, it is timely to begin expanding the scope of economic evaluation in this field. Future research must address the measurement of both costs and outcomes to understand more fully the role that palliative care plays in enhancing value in health care. Relevant domains for such research are identified.
    Journal of Palliative Medicine 07/2014; 17(9). DOI:10.1089/jpm.2013.0594 · 1.91 Impact Factor
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    ABSTRACT: Background For patients with advanced cancer, visits to the emergency department (ED) are common. Such patients present to the ED with a specific profile of palliative care needs, including burdensome symptoms such as pain, dyspnea, or vomiting that cannot be controlled in other settings and a lack of well-defined goals of care. The goals of this study are: i) to test the feasibility of recruiting, enrolling, and randomizing patients with serious illness in the ED; and ii) to evaluate the impact of ED-initiated palliative care on health care utilization, quality of life, and survival. Methods/Design This is a protocol for a single center parallel, two-arm randomized controlled trial in ED patients with metastatic solid tumors comparing ED-initiated palliative care referral to a control group receiving usual care. We plan to enroll 125 to 150 ED-advanced cancer patients at Mount Sinai Hospital in New York, USA, who meet the following criteria: i) pass a brief cognitive screen; ii) speak fluent English or Spanish; and iii) have never been seen by palliative care. We will use balanced block randomization in groups of 50 to assign patients to the intervention or control group after completion of a baseline questionnaire. All research staff performing assessment or analysis will be blinded to patient assignment. We will measure the impact of the palliative care intervention on the following outcomes: i) timing and rate of palliative care consultation; ii) quality of life and depression at 12 weeks, measured using the FACT-G and PHQ-9; iii) health care utilization; and iv) length of survival. The primary analysis will be based on intention-to-treat. Discussion This pilot randomized controlled trial will test the feasibility of recruiting, enrolling, and randomizing patients with advanced cancer in the ED, and provide a preliminary estimate of the impact of palliative care referral on health care utilization, quality of life, and survival. Trial registration Clinical Trials.gov identifier: NCT01358110 (Entered 5/19/2011).
    Trials 06/2014; 15(1):251. DOI:10.1186/1745-6215-15-251 · 1.73 Impact Factor
  • Fred C Ko · R Sean Morrison
    JAMA Internal Medicine 06/2014; 174(8). DOI:10.1001/jamainternmed.2014.999 · 13.12 Impact Factor
  • Peter May · Charles Normand · R. Sean Morrison
    EAPC World Research Congress, Lleida, Spain; 06/2014

Publication Stats

7k Citations
1,660.38 Total Impact Points


  • 1997–2015
    • Icahn School of Medicine at Mount Sinai
      • • Department of Emergency Medicine
      • • Department of Geriatrics and Palliative Medicine
      • • Department of Medicine
      Borough of Manhattan, New York, United States
  • 2008–2014
    • James J. Peters VA Medical Center
      Bronx, New York, United States
  • 2011
    • University of California, San Francisco
      • Division of Geriatrics
      San Francisco, CA, United States
    • Weill Cornell Medical College
      • Division of Geriatrics and Gerontology
      New York City, New York, United States
  • 1995–2010
    • Mount Sinai Medical Center
      New York City, New York, United States
  • 2009
    • Medical College of Wisconsin
      • Palliative Care Center
      Milwaukee, Wisconsin, United States
  • 2007
    • University of Pittsburgh
      • Section of Palliative Care and Medical Ethics
      Pittsburgh, Pennsylvania, United States
  • 2002
    • University of Washington Seattle
      Seattle, Washington, United States
  • 2001
    • University at Albany, The State University of New York
      • Department of Health Policy, Management, and Behavior
      New York, New York, United States