October 16, 2023
Blood transfusion for outpatients in hospice care can be challenging, whether the person is in a care facility or at home. Some hospice providers consider blood transfusion to be a disease-modifying treatment and do not include transfusion in their end-of-life services. Others do not provide outpatient transfusion because of inadequate reimbursement by Medicare. Still others may cite insurmountable logistic challenges in delivering blood to patient homes. The session on “Hope in Blood: Outpatient Transfusions in the Hospice Patient Population” acknowledged the challenges, but also offered ways that facilities can improve care for hospice patients who need transfusion while building an additional revenue stream in the process.
Why It Matters
Joshua Glover, MD, hematology/oncology fellow at the Stephenson Cancer Center of University of Oklahoma in Oklahoma City, highlighted the goal of hospice care as enhancing the quality of life for patients who are in the last phase of incurable disease (average of 3-6 days before death). He also identified the two criteria for patients entering hospice care: 1) patient life expectancy is no more than 6 months; and 2) patients must agree to forgo any curative treatments and focus on quality of life, comfort and symptom management (eg, pain, nausea, anorexia, anxiety, depression, shortness of breath, fatigue).
After briefly reviewing the meta-analyses and other reports on hospice care in the literature, Glover detailed a study conducted at his facility. The study investigated the feasibility, transfusion reaction incidence, quality of life, symptom improvement and hospice outcomes in patients with hematologic malignancies who received palliative transfusion at home. The findings included the following conclusions:
Further work is needed to identify financial support (through Medicare reimbursement).
Specifics of the study results included an average of 2.6 transfusions per patient, an absence of transfusion reactions and a mean post-study hemoglobin level of 6.64 g/dL and platelet count of 23.83 g/dL.
Call to Action
Tina S. Ipe, MD, MPH, chief medical officer at Our Blood Institute in Little Rock, Ark., gave a brief overview of hospice care in the United States, noted the benefits of out-of-hospital blood transfusion and touched on the challenges currently faced. She discussed the four different care teams involved in support of transfusions for hospice patients: hospice team (consents, samples, transfusion orders), blood center (testing and issue), hospice and blood center nurses (transfusion administration) and study coordinators (follow-up on quality-of-life indicators after each transfusion events).
Ipe pinpointed the benefits to blood centers that become transfusion providers for hospice patients, including development of revenue streams for supplying the blood products in addition to the nursing staff. She updated the audience members on initiatives by federal legislators and recommendations by the American Society of Hematology.
As a key take-away message, she shared a call-to-action list as follows:
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