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 

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.

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.

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 

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 

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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