Success | Failure | |
---|---|---|
Patient | Male, >90 years old | Female, between 80 and 90 years old |
Diagnosis | Heart disease, renal failure, cardiac cachexia | Progressive dysphagia from pharyngeal cancer |
Hospitalisations | 5 (4 in first 6 months) | 1 |
Result | Patient lived 9 months past prognosis and passed away at home | Patient admitted to SNF after 6 days at home |
Factors | • Family member as sole care coordinator, lived in
• 3.6 clinic visits per months | • Incorrectly assessed that patient / homecare could manage g-tube |
• Responsive, well-connected homecare nurse(s) consistently updated PCP | • Case management, PCP and homecare failed to find acceptable solution | |
G-tube = gastrostomy tube; PCP = primary care physician; SNF = skilled nursing facility