What Does All this Mean from the Patient Perspective?

For patients, palliative care is a key to:• relieve symptom distress • navigate a complex and confusing medical system• understand the plan of care• help coordinate and control care options• allow simultaneous palliation of suffering along

with continued disease modifying treatments (no requirement to give up curative care)

• provide practical and emotional support for exhausted family caregivers

The Clinician Perspective

For clinicians, palliative care is a key tool to:

• Save time by helping to handle repeated, intensive patient-family communications, coordination of care across settings, comprehensive discharge planning

• Bedside management of pain and distress of highly symptomatic and complex cases, 24/7, thus supporting the treatment plan of the primary physician

• Promote patient and family satisfaction with the clinician’s quality of care

The Hospital PerspectiveFor hospitals, palliative care is a key tool to:

• Effectively treat the growing number of people with complex advanced illness

• Provide service excellence, patient-centered care• Increase patient and family satisfaction• Improve staff satisfaction and retention • Meet JCAHO quality standards• Rationalize the use of hospital resources, avoid

costs• Increase bed/ICU capacity, reduce costs• Invest in a Health Care Advisory Board best

practice with Grade A rating• Improve USNWR hospital ranking

Dr. M, an 89 year old practicing psychoanalyst

• Admitted to the hospital for scleroderma and new onset kidney failure.

• Declined hemodialysis. Palliative care consult called to assess patient’s capacity to refuse dialysis and to assure that she was not suicidal.

• Discharged home with hospice on day 5 of hospital stay.

• Did well at home for 4 months, remained in active clinical practice.

• Said good bye to her patients, her son, and her friends, then died quietly at home 3 days later.

Dr. M- How does palliative care deliver quality?• She received good hospital palliative care-

goals of care assessment and development of a care plan that met her goals, symptom management.

• Transitioned effectively to, and received good care from, hospice at home- Meticulous symptom management, psychosocial support from hospice RN, SW, MD + primary doc to patient and her distressed family and friends. Assured a peaceful dignified death at home.

Demonstrates how the palliative care quality continuum works well from the perspective of the patient and family, the providers, and the payers.

Dr. M’s Care- the Result of Hospice and Palliative Care Partnership

As a result of an effective partnership between a hospital palliative care program and a community hospice provider, Dr. M. received care that was:

Patient centered- goals were defined and met Beneficial- symptoms managed, family

supported Safe- no complications, injuries, errors Timely- palliative care from time of diagnosis

of end stage renal disease til death and bereavement

Efficient- avoided unwanted dialysis, hospitalizations, surgical procedures, imaging,

transport and $$$cost.

# of Hospital Based Palliative Care Programs in the United States,

2000-2004 (Source: AHA Annual Survey)

500

600

700

800

900

1000

1100

1200

2000 2001 2002 2003 2004

U.S. Hospital Based Palliative Care Programs (AHA Survey 2004)

“No institution is doing everything right. But we found 10 that are using innovation, hard work and imagination to improve care, reduce errors and save money.”

“But determined people . . . are transforming the way U.S. hospitals care for the most seriously ill patients. The engine of change is palliative medicine.

“The field is growing because it pays attention to the details,’ says Dr. Philip Santa-Emma … ‘It acknowledges that even if we can’t fix the disease, we can still take wonderful care of patients and their families.”

NewsweekFixing America’s Hospital Crisis

October 16, 2006