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Franciscan Health Systems of Tacoma, Washington, includes community hospitals, care centers, home care and hospice programs, and a physician health system network. The Breakthrough Series team aimed to improve patient access to supportive services as a way to increase patient and family satisfaction and reduce hospitalizations and emergency room visits. This team is credited with first using the "surprise" question, which it used to encourage doctors to refer patients to supportive care. The team asked doctors, "Would you be surprised if this patient died within the year?" Using this approach, referrals increased from one each month to six. The enhanced referrals and the improved services ended up yielding better care and a 400 percent increase in hospice revenues. (This increased revenue has helped to extend the program to other facilities throughout the Franciscan system).
Community volunteers were a key element in helping patients find and use supportive services. The eight volunteers were mostly women who had recently retired from positions that had made them very involved in the community. Each month, sometimes more often, the volunteers called patients and caregivers to discuss their needs and recommend appropriate services. These conversations also gave patients a chance to express their concerns, fears, and worries. Volunteers let program staff know how patients responded and whether additional services or help was needed. The program also ensured that patients had opportunities to make plans for future care.
The team found that once supportive services were in place, patient satisfaction with end-of-life care improved dramatically. The following chart shows just how much improvement the team managed in seven months. In the first month of enrollment, more than 60 percent said that their satisfaction was no better than before Supportive Services started or was poor; seven months later, 100 percent reported that their satisfaction was a lot better or excellent. Remember, these were patients who were, at the same time, becoming sicker.
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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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