Latest Trends and Insights from the National Palliative Care Registry™

Maggie Rogers, MPH

Director of Research, CAPC

Rachael Heitner, MA, CHPCA

Research Manager, CAPC

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Latest Trends and Insights from the National Palliative Care Registry™

Maggie Rogers, MPH

Director of Research, CAPC

Rachael Heitner, MA

Research Manager, CAPC

Poll Question

Have you (or your organization) ever submitted data to the National Palliative Care Registry™?

→Yes

→No

The National Palliative Care Registry™

→Annual survey on palliative care program’s operations, service delivery, and processes

→Programs participate once a year

→No patient-level data or patient-reported outcomes

→Purpose:

→Provide actionable data that programs can use to secure and retain resources

→Promote standardization of structure and process

→Support the establishment of new palliative care programs

Free and open to all hospital and community programs

2018 Updates

→Focused Scope

→Survey Reorganization

→Length and Question Changes

→One of Many Data Resources

Who Were Our 2018 Inpatient Participants?

2018 Hospital Survey Adult Programs: 425 Participants

86%

7%7%

Hospital

Office Practice or

Home Health Agency

Hospice

Admin

Home

92% are

Not-for-Profit Hospitals

51% are

Teaching Hospitals

21%

29%

50% Bed

Size

< 150 Beds

150-300 Beds

> 300 Beds

22% 35% 25% 18%

Region

Northeast South Midwest West

2018 Hospital Survey Pediatric Programs: 54 Participants

100%

Hospital

Admin

Home

85% are

Not-for-Profit Hospitals

100% are

Teaching Hospitals

17%

39%

44% Bed

Size

< 150 Beds

150-300 Beds

> 300 Beds

15% 37% 24% 24%

Region

Northeast South Midwest West

Patient Encounters

Palliative Care Service Penetration

Palliative care service penetration is the percentage of annual hospital admissions seen by the palliative care team. Penetration is used to determine how well palliative care programs are reaching patients in need.

100 initial consults / 3,500 hospital admissions = 2.9% penetration

Penetration has increased 124% since 2008 (Adult Programs)

2.52.7

2.8

3.1

3.5

4.0

4.4

4.85.0

5.3

5.6

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Mean Penetration Median Penetration

Differences in Penetration Rates, Adults (2018)

→Bed Size: Hospitals with more than 300 beds see an average of 4.7% compared to 6.4% in hospitals with less than 300 beds

→Teaching Status: Teaching hospitals see an average of 5.2% compared to 6.0% of programs in non-teaching hospitals

Differences in Penetration Rates, Adults (2018)

→Consult Triggers: Hospitals with automatic screening criteria see an average of 6.2% compared to 5.1% for hospitals without it in place

→Program Maturity: programs who are three years old or less see an average of 4.4% compared to 5.7% for programs who are four years old or older

Patient Encounters, Adults (2018)

Initial Consults 892

• Larger hospitals provide a larger number of initial consults

• 1,223 for large hospitals with 300+ beds compared to 358 for small hospitals with <150 beds

Follow-Up Visits 1,761

• Larger hospitals provide a larger number of follow-up visits

• 2,499 for large hospitals with 300+ beds compared to 474 for small hospitals with <150 beds

Visits per Patient 2.8

• 1 initial consult + 1.8 follow-up visits per patient during a single admission

• 3.0 for large hospitals with 300+ beds compared to 2.4 for small hospitals with <150 beds

Patient Encounters, Pediatrics (2018)

Penetration Rate 3.1%

• Based on the hospital’s pediatric admissions

Initial Consults 293

• Larger hospitals provide a larger number of initial consults

Follow-up Visits 1,253

• Larger hospitals provide a larger number of follow-up visits

Visits per Patient

5.3

• 1 initial consult + 4.3 follow-up visits per patient during a single admission

Program Staffing

84.2%

82.1%

68.7%

54.4%

39.6%

33.4%

32.2%

30.3%

10.7%

8.6%

7.2%

6.0%

4.3%

3.6%

3.6%

3.3%

3.3%

2.9%

2.1%

1.9%

1.2%

1.2%

0.5%

Advanced Practice Registered Nurse

Physician

Social Worker

Chaplain

Registered Nurse

Administrative Support

Program Administrator (Non-Clinician)

Medical Director

Fellow

Pharmacist

Physician Assistant

Hospice Liaison

Music/Art Therapist

Child Life Specialist

Nutritionist/Dietician

Resident

Massage Therapist

Ethicist

Physical/Occupational Therapist

Psychologist

Licensed Practical/Vocational Nurse

Doula

Psychiatrist

Core interdisciplinary team disciplines are the most prevalent.

41% of participating

programs report a full,

core interdisciplinary team

(Physician, APRN or RN,

Social Worker, and

Chaplain)

Percent of Programs Reporting Specific Staff Disciplines, Adults (2018)

74.1%

96.3%

66.7%

48.1%

61.1%

53.7%

33.3%

33.3%

38.9%

7.4%

5.6%

5.6%

16.7%

29.6%

7.4%

14.8%

7.4%

9.3%

7.4%

22.2%

1.9%

1.9%

1.9%

Advanced Practice Registered Nurse

Physician

Social Worker

Chaplain

Registered Nurse

Administrative Support

Program Administrator (Non-Clinician)

Medical Director

Fellow

Pharmacist

Physician Assistant

Hospice Liaison

Music/Art Therapist

Child Life Specialist

Nutritionist/Dietician

Resident

Massage Therapist

Ethicist

Physical/Occupational Therapist

Psychologist

Licensed Practical/Vocational Nurse

Doula

Psychiatrist

Pediatric programs have different staffing models than adult programs.

37% of participating

programs report a full,

core interdisciplinary team

(Physician, APRN or RN,

Social Worker, and

Chaplain)

Percent of Programs Reporting Specific Staff Disciplines, Pediatrics (2018)

Program Staff FTEs, Adults (2018)

0.30.6

1.80.8

1.2

2.0

0.3

0.5

0.7

0.5

0.6

1.0

0.2

0.3

0.5

2.1

3.2

6.0

< 150 Beds 150-300 Beds > 300 Beds

Physician APRN RN Social Worker Chaplain

FTE: Full-Time Equivalent

APRN FTE have seen the most growth since 2008, with a 150% increase in hospitals with 300+ beds

The largest growth in staff FTEs has been in large hospitals.

FTE: Full-Time Equivalent

2.02.02.3

3.2

3.1

6.1

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

< 150 Beds 150-299 Beds 300+ Beds

Growth in Staffing FTE in the Interdisciplinary Team, Adults (2018)

Interdisciplinary Team: Physician, APRN, RN, SW, Chaplain

Program Staff FTEs, Pediatrics (2018)

1.4

1.0

0.7

0.7

0.2

4.1

Chaplain

Social Worker

RN

APRN

Physician

FTE: Full-Time Equivalent

Over time comparisons

are unavailable, as

there is not enough

historical data

HPM-Certified Clinicians (2018)

Adults

→83% had a certified physician

→61% had a certified APRN

→25% had a certified RN

→24% had a certified social worker

→8% had a certified chaplain

Pediatrics

→92% had a certified physician

→38% had a certified APRN

→24% had a certified RN

→7% had a certified social worker

→9% had a certified chaplain

Of the programs that reported (at least one) Hospice and Palliative

Medicine-certified staff members:

More adequately staffed programs see a larger percentage of annual hospital admissions, Adults (2018)

3.9

4.8

5.5

7.6

< 1.5 FTE per 10,000Admissions

1.5-2.0 FTE per 10,000Admissions

2.1-3.0 FTE per 10,000Admissions

> 3.0 FTE per 10,000Admissions

Mean Penetration Median Penetration

Based on: Interdisciplinary Palliative Care Team FTE per 10,000 Hospital Admissions

Billable Provider Workload, Adults (2018)

296

349

523

399

Penetration < 3.0% Penetration 3.0-4.0% Penetration 4.1-6.0% Penetration > 6.0%

Billable Provider Workload: Number of Initial Consults per 1 FTE of Physician, APRN, and PA

The number of initial

consults completed by

billable providers varies by

the hospital penetration rate

Program Features

What are the top three reasons for the palliative care consult requests you receive? (2018)

Adults

1. Establishing Goals of Care 91%

2. Pain Symptoms 55%

3. End-of-Life/Hospice Referral 46%

4. Advance Care Planning 42%

5. Family Support and Counseling 18%

Pediatrics

1. Establishing Goals of Care 83%

2. Pain Symptoms 43%

3. Family Support and Counseling 43%

4. Advance Care Planning 33%

5. Coordination of Care 32%

Top Referral Sources, Adults (2018)

Referring Locations

46.4%

25.9%

13.1%

7.4%

3.4%

Medical/Surgical

ICU

Step-Down

Oncology

Emergency Dept

Referring Specialties

50.9%

12.8%

12.8%

7.1%

6.2%

Hospitalist

Pulm/Critical Care

Internal Medicine

Family Medicine

Oncologist

Less than 1% came from Geriatrics,

Gastroenterology, Direct Admission,

Hospice, Pediatrics, Maternal

Medicine, and Neonatology (each)

3% or less came from Surgeons,

Cardiologists, Neurologists,

Nephrologists, Gastroenterologists,

Maternal Medicine, or Neonatologists

Primary Diagnoses, Adults (2018)

24.1%

12.9%

11.5%

7.7%

6.7%

6.0%

Cancer

Cardiac

Pulmonary

Neurologic

Complex Chronic

Infectious

Dementia, Renal, Gastro,

Hepatic, Trauma,

Vascular, Endocrine,

Hematology, Congenital,

Inutero, and Prematurity

each account for less

than 5 percent of patient

diagnoses

Palliative care programs frequently complete consults early during a patient’s admission.

Adults Pediatrics

16.7%

41.2%

33.3%

6.1%

0.2%

Always

Often

Sometimes

Rarely

Never

4.0%

48.0%

36.0%

12.0%

0.0%

Always

Often

Sometimes

Rarely

Never

Consult Timing: How often are consults completed within 48 hours of admission? (2018)

Palliative care programs strive to respond to consults requests quickly.

Adults Pediatrics

18.8%

65.3%

13.3%

2.4%

0.2%

Always

Often

Sometimes

Rarely

Never

10.2%

51.0%

32.7%

6.1%

0.0%

Always

Often

Sometimes

Rarely

Never

Consult Timing: How often are consults completed within 24 hours of referral? (2018)

Patient Disposition, Adults (2018)

23.4%

20.8%

17.6%

14.4%

12.3%

Home without Hospice

Other Health Care Facility

Expired

Home with Hospice

Hospice-Health Care Facility

An additional 7% were

either discharged to acute

care facility, left AMA, or

were not discharged from

the hospital during the

reporting period

National Guidelines & Recommendations

Adults PediatricsNational Consensus Project (NCP) Clinical

Practice Guidelines for 76.2% 51.9%Quality Palliative Care

The Joint Commission Advanced

Certification for Palliative Care 35.8% 20.4%

DNV-GL Healthcare Palliative Care

Program Certification 4.5% 3.7%

Does your program follow any national recommendations or guidelines? (2018)

Adherence to NCP Guidelines (2018)

Recommendation Adult Programs Pediatric Programs

24/7 Availability to Patients 46.1% 59.3%

Team Wellness Plan 57.1% 69.2%

Quality Improvement (QI) Plan 61.2% 44.4%

Physician on Team 82.1% 96.3%

Social Worker on Team 68.7% 66.7%

Chaplain on Team 54.4% 48.1%

(At Least One) HPM-Certified Clinician 83.8% 84.9%

Program Funding

What are your Top Three Program Funding Sources? (2018)

Adults

1. Hospital/Parent Organization Financial Support 86%

2. Fee-for-Service Clinician Billing 75%

3. Philanthropy 19%

Pediatrics

1. Hospital/Parent Organization Financial Support 85%

2. Fee-for-Service Clinician Billing 65%

3. Philanthropy 63%

Website: registry.capc.org

Email: registryhelpdesk@capc.org

Phone: 212-201-2689

National Palliative Care Registry™

→ The Registry is free and open to all

palliative care programs

→ CAPC Membership is not required to

participate

Questions?