Improving Care for the End of Life, Online Edition The Palliative Care Policy Center

Sourcebook : Improving Care for the End of Life : 16.1 Offer Tailored End-of-Life Services to Patients with Advanced Heart or Lung Disease

By providing supportive end-of-life services to patients with advanced heart failure and lung disease, organizations can improve the quality of life for patients, in part by helping them manage symptoms, prevent exacerbations, and avoid stressful and frightening emergency room visits and hospitalizations. By teaching patients to manage their symptoms at home, programs give them greater control over their lives and some sense of mastery over their disease. By applying models of good end-of-life care to the treatment of late-stage heart disease, programs can help patients live well.

According to data from the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment, or SUPPORT, patients with lung cancer are 24 times more likely to be enrolled in hospice at the time of hospital discharge than are CHF patients, even after adjusting for variables such as DNR preferences, functional status, disease severity, and demographics. Instead of being enrolled in a comprehensive service system, the majority of CHF patients go through the disheartening cycle of repeated emergency room visits and hospitalizations, finally dying suddenly or as the result of a failed attempt at rescue from an acute decompensation.

Hope Hospice in Florida achieved breakthrough results in improving access to hospice services for advanced cardiac disease patients. The team aimed to improve care for these patients by:

The team followed the PDSA principle of starting with a small number of patients or clinicians with whom to test changes. For example, an emergency cardiac care medication kit for home use was initially tried with one cardiologist, four hospice nurses, and five cardiac patients. Over time, the team built on its success to include more patients; the team is now showing other Florida hospices how they, too, can meet the needs of these patients.

After a year of sustained activity, including outreach to area cardiologists and ICUs to increase hospice referrals, Hope found:

Hope found that its program reduced inpatient hospital days for cardiac patients by 40 days per year, with projected annual savings of $45,680 for a population of seven patients.

Reducing Cardiac Inpatient Days via Hospice Protocalls, Hope Hospice and Palliative Care, Ft. Myers, FL. Increasing Cardiac Referrals via Inpatient Facility via Educational Intervention, Hope Hospice, Ft. Myers, FL.

16.1.1 Case Study - Kaiser Permanente Bellflower
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].

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