Evaluation Indicators for Hospice

The following indicators are extracted from "Medical Guidelines For Determining Prognosis in Selected Non-Cancer Diseases, Second Edition", published by the NHPCO. For a free copy of this publication send an email request to information@infinitycare.com.

• Illness with a life-limiting prognosis of <6 months; based on probability not certainty.
• Declining functional status in a majority of activities of daily living or a Palliative Performance Scale of <40%.
• Frequent hospitalizations, trips to the emergency room, or physician visits due to:
• Dehydration
• Hypovolemia
• Infections
• Pain Management
• Has a Serum Albumin less <2.6 gm/dl or has experienced weight loss of >10% over 6 month period.
• The patient and/or the caregivers are experiencing stress or difficulty managing the amount of care/assistance the patient requires.
• Recurrences of aspirations pneumonia, positive blood cultures or upper urinary tract infections.
• Body Mass Index below 22kg/m2 to calculate see BMI Chart.
• Shortness of breath or chest pain with movement or minimal activity = NYHC IV Ejection fraction <20%.
• History of syncope, dangerous arrhythmia, prior cardiac arrest or near code situation.
• Cardiogenic brain embolism.
• Vital lung capacity <30% of predicted value or FEV1 decreasing >40 ml/year.
• Tracheostomy, ventilator or artificial feeding indicated but not elected/discontinued.
• Resting tachycardia > 100 bpm or Hypotension <90mmHg systolic blood pressure (persistent).
• Hypoxia (Sao2<89% or pO2<56mmHg) or Hypercapnia (pCO>49mmHg).
• Right heart failure due to lung disease.
• Cyanosis, retractions or accessory muscle us (persistent).
• Prothrombin time increased by 5 seconds or INR of 1.5 or more, not on anticoagulants.
• Refractory ascities or bacterial peritonitis
• Hepatorenal syndrome (urine output<20 cc/hr).
• Refractory encephalopathy or esophageal variceal bleeding.
• Active Hepatitis or Alcoholism (>40gm/day) with age of 65 or greater.
• Creatine over 8mg/dl, not utilizing dialysis.
• Stroke area >30%, midline shift >1.5cm, bihemispheric or basilar artery occlusion.
• Cancer when curative care likely to be ineffective or declined.

To refer a patient for evaluation: referralmessage@inifinitycare.com