Hospital palliative care consult improves value-based purchasing outcomes in a propensity score-matched cohort.

BACKGROUND: Hospital-based palliative care consultation is consistently associated with reduced hospitalization costs and more importantly with improved patient quality of life. As healthcare systems move toward value-based purchasing rather than fee-for-service models, understanding how palliative care consultation is associated with value-based purchasing metrics can provide evidence for expanded health system support for a greater palliative care presence. AIM: To understand how a palliative care consultation impacts rates of patient readmission and hospital-acquired infections associated with value-based purchasing metrics. DESIGN: Retrospective propensity-matched case-control study evaluating the impact of palliative care consultation on hospital charges, hospital and intensive care unit length of stay, readmission rates, and rates of hospital-acquired conditions. SETTING/PARTICIPANTS: All adult patients admitted to a two hospital healthcare system over a 2-year period from 1 April 2015 to 31 March 2017. The palliative care team involved three physicians, five advanced practice providers, a social worker, and a chaplain during the study period. RESULTS: A total of 3415 patients receiving a palliative consult were propensity matched to 25,028 controls. Compared to controls, cases had decreased charges per day and decreased rates of 7-, 30-, and 90-day readmissions. CONCLUSION: Through value-based purchasing, hospitals have 3% of their Medicare reimbursements at risk based on readmission rates. By clarifying prognosis and patient goals, palliative care consultation reduces readmission rates. Hospital systems may want to invest in larger palliative care programs as part of their efforts to reduce hospital readmissions.

Innovation in Ontario's Family Health Teams: How Palliative and Coordinated Care Programs Are Filling Service Gaps and Keeping Patients at Home.

Collaborative interprofessional primary care (PC) teams are widely seen as an essential attribute of high-performing PC systems (Aggarwal and Hutchinson 2012). Effective PC teams play a key role in the mobilization of healthcare resources and navigation of the health and social care system for their patients. In Ontario, the establishment of Family Health Teams has resulted in the implementation of unique programs that deliver services to palliative and elderly patients with a focus on keeping them at home and out of hospital. Case studies cited in this article highlight two innovative programs in Family Health Teams and provide perspectives on lessons for successful implementation.

What students experienced: a narrative analysis of essays written by first-year medical students participating in a geriatrics home visit.

OBJECTIVES: To develop a house call experience for first-year medical students introducing them to challenges that homebound, chronically ill elderly adults face. DESIGN: During the semester, two students were paired with a preceptor to see two to three patients. SETTING: The house call practices of the Division of Geriatric Medicine at the University of Pennsylvania and the Philadelphia Veterans Affairs Hospital. PARTICIPANTS: One hundred sixty-five first-year medical students. MEASUREMENTS: Pairs of students worked together to write an essay after the visit. Essays addressed specific areas, as detailed in a provided checklist, including noting patients' functional limitations, identifying community supports available to patients, and writing about general surprises that the students discovered during their visit. These data were then measured using narrative analysis. RESULTS: In all domains, students identified core goals and objectives. In the first domain (meeting challenges of functional limitations), students recognized the importance of family support. In the second domain (mentioning of functional limitation), high levels of compliance were seen. In the third domain (community support), students mentioned specific formal supports. In the fourth domain (surprises during the visit), students identified many important geriatrics concepts. CONCLUSION: In writing their essays, students demonstrated a high level of recognition of functional impairment and noted the importance of family, social networks, and home environment in enabling homebound, chronically ill elderly adults to stay in their homes. Many students also demonstrated an awareness of the possibilities of independence and happiness despite significant illness and disability.