R Sean Morrison

James J. Peters VA Medical Center, Bronx, New York, United States

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Publications (191)1698.96 Total impact

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    ABSTRACT: Importance The delivery of palliative care is not standard of care within most emergency departments (EDs).Objective To compare quality of life, depression, health care utilization, and survival in ED patients with advanced cancer randomized to ED-initiated palliative care consultation vs care as usual.Design, Setting, and Participants A single-blind, randomized clinical trial of ED-initiated palliative care consultation for patients with advanced cancer vs usual care took place from June 2011 to April 2014 at an urban, academic ED at a quaternary care referral center. Adult patients with advanced cancer who were able to pass a cognitive screen, had never been seen by palliative care, spoke English or Spanish, and presented to the ED met eligibility criteria; 136 of 298 eligible patients were approached and enrolled in the ED and randomized via balanced block randomization.Interventions Intervention participants received a comprehensive palliative care consultation by the inpatient team, including an assessment of symptoms, spiritual and/or social needs, and goals of care.Main Outcomes and Measures The primary outcome was quality of life as measured by the change in Functional Assessment of Cancer Therapy–General Measure (FACT-G) score at 12 weeks. Secondary outcomes included major depressive disorder as measured by the Patient Health Questionnaire-9, health care utilization at 180 days, and survival at 1 year.Results A total of 136 participants were enrolled, and 69 allocated to palliative care (mean [SD], 55.1 [13.1] years) and 67 were randomized to usual care (mean [SD], 57.8 [14.7] years). Quality of life, as measured by a change in FACT-G score from enrollment to 12 weeks, was significantly higher in patients randomized to the intervention group, who demonstrated a mean (SD) increase of 5.91 (16.65) points compared with 1.08 (16.00) in controls (P = .03 using the nonparametric Wilcoxon test). Median estimates of survival were longer in the intervention group than the control group: 289 (95% CI, 128-453) days vs 132 (95% CI, 80-302) days, although this did not reach statistical significance (P = .20). There were no statistically significant differences in depression, admission to the intensive care unit, and discharge to hospice.Conclusions and Relevance Emergency department–initiated palliative care consultation in advanced cancer improves quality of life in patients with advanced cancer and does not seem to shorten survival; the impact on health care utilization and depression is less clear and warrants further study.Trial Registration clinicaltrials.gov Identifier: NCT01358110
    No preview · Article · Jan 2016
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    ABSTRACT: Patients with multiple serious conditions account for a high proportion of health care spending. Such spending is projected to continue to grow substantially as a result of increased insurance eligibility, the ever-rising cost of care, the continued use of nonbeneficial high-intensity treatments at the end of life, and demographic changes. We evaluated the impact of palliative care consultation on hospital costs for adults with advanced cancer, excluding those with dementia. We found that compared to usual care, the receipt of a palliative care consultation within two days of admission was associated with 22 percent lower costs for patients with a comorbidity score of 2–3 and with 32 percent lower costs for those with a score of 4 or higher. Earlier consultation was also found to be systematically associated with a larger cost-saving effect for all subsamples defined by multimorbidity. Given ongoing workforce shortages, targeting early specialist palliative care to hospitalized patients with advanced cancer and higher numbers of serious concurrent conditions could improve care while complementing strategies to curb the growth of health spending.
    Preview · Article · Jan 2016 · Health Affairs
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    ABSTRACT: Background: Over the past decade over two-thirds of U.S. hospitals have established palliative care programs. National data on palliative care program staffing and its association with operational outcomes are limited. Objective: The objective of this report is to examine the impact of palliative care program staffing on access to palliative care in U.S. hospitals. Methods: Data from the National Palliative Care Registry™ for 2014 were used to calculate staffing levels, palliative care service penetration, and time to initial palliative care consultation for 398 palliative care programs operating across 482 U.S. hospitals. Results: Hospital-based palliative care programs reported an average service penetration of 4.4%. Higher staffing levels were associated with higher service penetration; higher service penetration was associated with shorter time to initial palliative care consultation. Discussion: This report demonstrates that operational effectiveness, as measured by staffing and palliative care service penetration, is associated with shorter time to palliative care consultation.
    Full-text · Article · Nov 2015 · Journal of palliative medicine
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    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.
    Full-text · Article · Sep 2015 · Journal of palliative medicine
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    Amy S Kelley · R Sean Morrison

    Preview · Article · Aug 2015 · New England Journal of Medicine
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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.
    No preview · Article · Jun 2015 · Journal of Clinical Oncology
  • R Sean Morrison

    No preview · Article · Apr 2015 · Journal of palliative medicine
  • K. Todd · E. Dickman · U. Hwang · S. Akhtar · R. Morrison

    No preview · Article · Apr 2015 · Journal of Pain
  • 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).
    No preview · Conference Paper · Feb 2015
  • Peter May · R. Sean Morrison

    No preview · Conference Paper · Feb 2015
  • Corita Grudzen · Lynne Richardson · R. Sean Morrison

    No preview · Article · Feb 2015 · Journal of Pain and Symptom Management
  • Amy Kelley · Kenneth Covinsky · R. Sean Morrison · Christine Ritchie

    No preview · Article · Feb 2015 · Journal of Pain and Symptom Management

  • No preview · Article · Feb 2015 · Journal of Pain and Symptom Management

  • No preview · Article · Feb 2015 · Journal of Pain and Symptom Management
  • Katherine Ornstein · Vivian Yeh · Joan Penrod · R. Sean Morrison · Diane Meier

    No preview · Article · Feb 2015 · Journal of Pain and Symptom Management
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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.
    No preview · Article · Jan 2015 · Academic Emergency Medicine
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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.
    Full-text · Article · Dec 2014 · Journal of Pain and Symptom Management
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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.
    Full-text · Article · Sep 2014 · Pain
  • Peter May · R. Sean Morrison · Charles Normand

    No preview · Conference Paper · Jul 2014
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    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.
    Full-text · Article · Jul 2014 · Journal of Palliative Medicine

Publication Stats

8k Citations
1,698.96 Total Impact Points

Institutions

  • 2008-2015
    • James J. Peters VA Medical Center
      Bronx, New York, United States
  • 1997-2015
    • Icahn School of Medicine at Mount Sinai
      • • Department of Geriatrics and Palliative Medicine
      • • Department of Emergency Medicine
      • • Department of Medicine
      Borough of Manhattan, New York, United States
  • 2011
    • Weill Cornell Medical College
      • Division of Geriatrics and Gerontology
      New York City, New York, United States
  • 1996-2010
    • 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
  • 2000
    • University of Chicago
      Chicago, Illinois, United States
  • 1998
    • McMaster University
      Hamilton, Ontario, Canada