UCH Supportive Care for High Risk Patients

Background

The University HealthSystem Consortium (UHC) recently conducted a retrospective analysis of patient data from a number of hospitals, including Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital (BWH), to evaluate inpatient palliative care services delivered to patients the UHC considered “high risk” and appropriate for palliative care. 

“High risk” patients are defined by the UHC as adults who are inpatients for at least 4 days who either a) die in the hospital or b) have had multiple admissions for serious illnesses (again defined by the UHC) in the preceding 12 months.

The UHC audit provided clear evidence that even in well established palliative care services such as MGH and BWH, only a fraction of patients and family members who could potentially benefit from palliative care actually received such services. Improving access to excellent palliative care is therefore an important priority for hospitals as they strive to provide the best care and quality of life for their patients.

As part of a Quality Improvement (QI) initiative, MGH and BWH are currently piloting a new screening procedure focused on improving access to palliative care services and rates of palliative care consultations amongst “high risk” patients. This QI intervention has therefore presented us with a unique opportunity to address one of the central issues in palliative care:  how do we define and reach the population who could benefit from palliative care services? In answering this important question, data is being systematically gathered and analyzed so that a number of other important palliative medicine research hypotheses which are outlined below can be tested.

Objectives

To develop screening and identification procedures that accurately identify those patients who may be suitable for palliative care consultation at MGH and BWH and to increase the rate of consultations for the “high-risk” group defined by the UHC.

Research questions

(i) Can effective screening and identification procedures be developed to identify patients suitable for palliative care?   
(ii) How willing are physicians to accept a palliative care consultation for patients identified as “high risk”?
(iii) Does the screening process or palliative care consultation affect patient outcomes such as rates of palliative care consultations in the non-oncology patient population, length of stay, readmission rates, use of intensive care, costs associated with each admission, patient pain scores, rate of completion of health care proxy forms and Massachusetts comfort care forms, limitations of life sustaining treatment, hospice referrals and utilization, and family satisfaction?
IRB approval was granted in 2008. Data collection will be completed in early 2010.

For Additional Information, please feel free to contact any member of the Supportive Care for High Risk Patients team: J. Andrew Billings, MD, Sandra Nasrallah MD, Amelia Cullinan MD, Connie Dahlin NP, Robin Wilson, Research Nurse, and Danielle Ko MD.  Everyone can be reached via Partners Telephone Directory, e-mail, or extension 49197.