Clinical Diagnosis
Palliative Care Triggers
Hospice Indicators
EPD Wavier Case Management
Referral Opportunities
100

Progressive cognitive disorder associated with increasing functional decline.

Dementia

100

Unintentional loss of body weight over time.

Weight Loss

100

Primary focus of hospice care.

Comfort

100

Process of connecting members to needed services.

Care Coordination

100

Service that can occur alongside curative treatment.

Palliative Care

200

Chronic disease commonly associated with dyspnea and repeated exacerbations.

Chronic Obstructive Pulmonary Disease

200

Increasing need for assistance with activities of daily living.

Functional Decline

200

Expected course of illness used in eligibility discussions.

Prognosis

200

Regular review of services and needs.

Monitoring

200

Discussion exploring what matters most to a member.

Goals of Care

300

Diagnosis often linked to fluid overload and recurrent admissions.

Congestive Heart Failure

300

Repeated emergency department visits or admissions.

Hospitalizations

300

Progressive wasting syndrome in advanced illness.

Frailty

300

Document outlining goals and services.

Care Plan

300

Support focused on symptom management and quality of life.

Supportive Care

400

Advanced kidney disease requiring dialysis discussions.

End Stage Renal Disease

400

Persistent symptom often rated on a 0 to 10 scale

Pain

400

Referral associated with rapid decline and recurrent infections.

Hospice

400

Discussing future treatment wishes.

Advance Care Planning

400

Documentation of medical treatment preferences.

Medical Orders for Life-Sustaining Treatment

500

Diagnosis frequently prompting supportive care for symptom burden.

Cancer

500

Stress experienced by an unpaid support person.

Caregiver Burden

500

Term used for unexplained decline, weakness, and weight loss.

Failure to Thrive

500

Supporting member-centered decisions.

Advocacy

500

Referral suggested by hospitalizations, symptom burden, decline, and caregiver stress.

Palliative Care

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