Guías Médicas por Condición

COPD and Lung Disease

 

Hospice eligibility guidelines for COPD and lung disease are: 

Major characteristics

  • Dyspnea at rest or with minimal exertion 

  • Dyspnea unresponsive or poorly responsive to bronchodilator therapy 

  • Progression of chronic pulmonary disease as evidenced by one or more of the following: 

  • Frequent use of medical services, including hospitalizations, emergency visits and/or physician outpatient visits, due to symptoms of pulmonary disease. 

  • Frequent episodes of bronchitis or pneumonia.

  • Unintentional weight loss of ≥ 10 percent body weight over the preceding six months. 

  • Progressive inability to independently perform various activities of daily living (ADL's) or an increasing dependency with ADL's, resulting in a progressively lower performance status.

Other important critical factors

  • Cor pulmonale 

  • Continuous chronic oxygen therapy 

  • Resting tachycardia > 100/minute 

  • Steroid-dependent 

  • Cyanosis 

Abnormal laboratory findings 

While these laboratory studies may be helpful to the clinician when considering patient appropriateness for hospice services, they are not required for patient admission. 

  • FEV1 ≤ 30 percent predicted post-bronchodilator 

  • Serial decreases in FEV1 of at least 40 ml/year over several years 

  • PO2 ≤ 55 on room air 

  • O2 sat. ≤ 88 percent on room air 

  • Persistent hypercarbia (PCO2) ≥ 50 mm HG 

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Hospice Clinical Appropriateness: End-Stage COPD and Other Forms of Lung Disease 

Physicians may use clinical guidelines to identify patients in the final six months of lung disease. When it comes to end-of-life care, patients should be both physiologically and psychologically hospice-appropriate.

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Hospice care is designed to help patients who: 

  • Are dyspneic at rest or with minimal exertion 

  • Have progressed to the point where they spend most of their days at home 

  • Have experienced repeated emergency visits (one or more each quarter) due to infection or episodes of respiratory failure 

  • Have endured repeated hospitalizations (one or more each quarter) and no longer wish to be admitted 

  • No longer wish to be intubated 

Hospicio Toque de Amor counsels patients and their families about their goals and alternative ways to manage symptoms to prevent unwanted hospitalization and intubation.

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Types of nonmalignant, life-limiting, chronic lung diseases: 

  • Chronic obstructive pulmonary disorder (COPD) 

  • Emphysema 

  • Chronic bronchitis 

  • Chronic asthma 

  • Bronchiectasis 

  • Pulmonary fibrosis 

  • Cystic fibrosis 

  • End-stage tuberculosis 

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Specialized Hospice Program for Patients with End-Stage COPD and Other Lung Diseases 

Dyspnea and the anxiety it causes are two of the most distressing symptoms that patients experience. These can often be treated using a combination of clinical therapies and the individual, 24-hour support that hospice offers. The hospice plan of care for end-stage lung disease includes: 

  • Comprehensive evaluation by all members of the interdisciplinary team 

  • Pre-emergency care planning consistent with the patient’s needs and goals 

  • Pharmacologic and non-pharmacologic interventions to reduce episodes of respiratory distress 

  • 24-hour response upon onset of respiratory distress using a customized emergency protocol 

  • Caregiving objectives focused on improving the patient's quality of life 

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CMS Medicare provides these guidelines as a convenient tool. They do not take the place of a physician's professional judgment.

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