Abstract W MP107: Palliative Care Referrals are Under-used
Bibliographic record
Abstract
Introduction: The National Institutes of Health Stroke Scale (NIHSS) is a well-validated predictor of 90-day functional outcomes. A score of ≥16 forecasts a high probability of death or severe disability. The palliative care (PC) needs of patients with serious or life-threatening stroke are enormous. Per PC standards and the American Stroke Association’s position statement on PC after stroke, customized PC should be available to patients and their families throughout the entire course of illness. Palliative care can be initiated in the hospital setting without limitations on life expectancy. The purpose of this project was to quantify NIHSS scores on admission compared to the percent of PC referrals made at 3 urban hospitals that use neurological pre-formatted orders, and have in-patient PC programs. Hypothesis: We hypothesized that In-patient PC referrals for stroke patients with NIHSS scores of ≥16 are low, in the context of pre-formatted orders that set the referral trigger at ≥ to 25. Methodology: Ischemic and hemorrhagic stroke cases discharged from Nov. 1, 2013-May 31, 2014 were reviewed retrospectively (674 total). NIHSS assessments were scored by stroke-certified RN staff on admission. Excluded were patients whose full NIHSS score was not documented, patients referred directly to hospice, and patients who left Against Medical Advice. Cases were examined for NIHSS score, and whether or not they were referred to PC. Results: Of 615 qualifying patients, 51 (8.3%) were referred for PC during their in-patient stay. The percentage with a NIHSS score on admission </= 6, was 3.5% (11/313). At a score of 7-15, 7.8% (15/188) received referrals. At scores ≥ 16, 21.9% (25/114) were referred. Conclusion: While the poor 90-day outcomes for patients with NIHSS scores ≥ 16 have been well-validated, just under 22% of the patients in this study received in-patient referrals to palliative care. Previously conducted studies relating NIHSS scores and 90-day outcomes suggest that there is an opportunity to improve the quality of life for more of these patients and their families through increased palliative care referrals.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".