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hospice guidelines for determining prognosis
General guidelines: (see more specific guidelines)
Eligibility:
General guidelines for hospice:
1) prognosis of 6 months or less as determined by 2 physicians
a) specific diagnosis
b) combination of factors
c) no specific diagnosis necessary
2) patient & or family must have elected treatment goals directed relief of symptoms, rather than cure of underlying disease
- a "do not resuscitate" status is not required
3) clinical progression of disease
a) multiple Emergency department visits or inpatient hospitalizations
b) Karnofsky performance index < 50
c) dependence in at least 3/6 basic activities of daily living (bADL)
d) progression past stage 7 of functional assessment scale
- functional assessment tool (FAST) score of 7c or worse [1]
4) recent impaired nutritional status
a) unintentional & progressive weight loss of > 10 lbs
b) serum albumin < 2.5 mg/dL
5) frailty itself is not a hospice qualifying diagnosis [2]
Related
albumin in serum/plasma
basic activities of daily living (bADL, Katz)
hospice
hospice worksheet for determining prognosis, general guidelines, all diagnoses
Karnofsky performance index (palliative performance scale)
weight loss
Specific
hospice guidelines for determining prognosis, amyotrophic lateral sclerosis (ALS)
hospice guidelines for determining prognosis, dementia
hospice guidelines for determining prognosis, heart disease
hospice guidelines for determining prognosis, HIV
hospice guidelines for determining prognosis, liver disease
hospice guidelines for determining prognosis, pulmonary disease
hospice guidelines for determining prognosis, renal disease
hospice guidelines for determining prognosis, stroke & coma
References
- Medical Guidelines for Determining Prognosis in non-Cancer
Diseases, 2nd edition, Stuart et al (eds), National Hospice
Organization, Arlington, VA, 1996
- NEJM Knowledge+