Center to Advance Palliative Care South 700 East suite 700, Salt Lake City, UT 84107

Transcription

1 Center to Advance Palliative Care South 700 East suite 700, Salt Lake City, UT 84107

2 HOUSEKEEPING To minimize feedback, please mute your line If you are using both a phone and computer, it is best to dial in first, then through your computer and select the connect via audio option when the window pops up, then mute your phone There will be several opportunities for questions. Please submit them using the Zoom question box Just a few announcements from the ACLC

3 AGENDA ACLC updates Introduction of guest presenters The Benefits of Palliative Care by Dr. Diane Meier, CAPC Palliative Care in Action by Dr. Daniel Hoefer, Sharp Healthcare Opportunity for Q&A Members can submit questions ahead of time by using the question box of the Zoom window

4 UPCOMING MEMBER EVENT(S) February 20 th ACLC Member Meeting at HIMSS17 Orlando, FL Co-located with the HIMSS17 Annual Conference Members of the ACLC are invited to attend a second Healthcare Conference day on Tuesday, February 21st hosted by Leavitt Partners Look for registration links in weekly news every Tuesday

5 THE BENEFITS OF PALLIATIVE CARE IN VALUE-BASED PROGRAMS Diane E. Meier, MD Director, Center to Advance Palliative Care Daniel Hoefer, MD CMO Palliative Medicine Sharp Healthcare

6 GUEST PRESENTER Dr. Diane Meier Director, Center to Advance Palliative Care Icahn School of Medicine at Mount Sinai

7 WHAT IS PALLIATIVE CARE? An added layer of support for quality of life- relief of pain, symptoms and stresses of serious illness Provided by an interdisciplinary team that works closely not only with treating physicians, but also with family caregivers Appropriate at any age and any stage of a serious illness Should be provided concurrent with disease treatment

8 An 88 year old man with dementia admitted via the ED for management of back pain due to prostate cancer, spinal stenosis and arthritis. Pain is 8/10 on admission, for which he is taking 5,000 mg of acetaminophen/day. Admitted 3 times in 2 months for pain (2x), falls, and altered mental status due to constipation. His family (83 year old wife) is overwhelmed. MR. B

9 MR B: BEFORE AND AFTER Usual Care 4 calls to 911 in a 3 month period, leading to 4 ED visits and 3 hospitalizations, leading to: Hospital acquired infection Functional decline Family distress Palliative Care House calls referral Pain management 24/7 phone coverage Support for caregiver Meals on Wheels Friendly visitor program No 911 calls, ED visits, or hospitalizations in last 18 months

10 WHO BENEFITS FROM PALLIATIVE CARE? Cancer Advanced liver disease COPD with oxygen CHF, Stroke Trauma Renal failure Dementia Diabetes with severe complications ALS Serious illness Frailty Functional Limitations Limitations in Activities of Daily Living (eating, bathing, dressing, toileting, transferring and walking) Exhausted family caregivers 911 Calls Emergency Department visits Hospital admissions Skilled nursing and rehab stays Home nursing and/or rehab High Utilization Graphic adapted from the National Consensus Project for Quality Palliative Care

11 Only a small portion of these patients are in the last year of life. Focus on end-of-life and prognosis misses the big opportunity for Improvement. Costliest 5% of Patients IOM Dying in America Report Appendix E Preferences-Near-the-End-of-Life.aspx 40% 11% 49% Last 12 months of life Short term high $ Persistent high $

12 EARLY AND CONCURRENT PALLIATIVE CARE MAKES A DIFFERENCE... Randomized trial simultaneous standard cancer care with palliative care co-management from diagnosis versus control group receiving standard cancer care only: Improved quality of life Reduced major depression Reduced aggressiveness (less chemo < 14d before death, more likely to get hospice, less likely to be hospitalized in last month) Improved survival (11.6 mos. vs 8.9 mos., p<0.02) Temel et al. Early palliative care for patients with non-small-cell lung cancer NEJM2010;363:

13 ... AND LEADS TO COST AVOIDANCE Setting Results Studies Inpatient Hospital Palliative Care $1,696 costs saved per admission for live discharges; $4,908 for death (Morrison, 2008) 43% fewer ICU admissions (Gade, 2008) Office-Based Palliative Care Home-Based Primary and Palliative Care Commercial Health Insurer Program In Primary Care: 20% fewer hospital admissions $117/day in oncology practice 33% lower costs ($ savings/day) 36% lower costs in ACO model ($12,000 saved per patient) 22% lower medical costs ($12,000 saved per member on program) (Trisolini 2006) (Greer 2016) (Brumley 2007) (Lustbader 2016) (Krakauer 2009)

14 14 THE 5 KEY CHARACTERISTICS OF EFFECTIVE PALLIATIVE CARE Target the highest risk people Ask people what matters most to them, and modify their care accordingly (Advance Health Care Planning) Ensure proactive pain/symptom management (Proactive Medical Management) Support family and other caregivers (Proactive Management) Provide 24/7 access

15 GUEST PRESENTER Dr. Daniel R Hoefer CMO Palliative Medicine Sharp Healthcare

16 SHARP TRANSITIONS PROGRAM: TARGET THE HIGHEST RISK PEOPLE Experiencing functional decline Hospitalization or ED visit due to advanced chronic illness Examples CHF NYHA stage 3 or greater COPD FEV1 <35%; on home oxygen Dementia FAST 5 score; assistance with IADLs 16

17 SHARP TRANSITIONS PROGRAM: HOW IT WORKS Care Team RN, MSW, Physician and Spiritual Care Services Active Phase 4-6 weeks of home visits with patient/family RN averages 6 visits; MSW 1-2 visits Maintenance Phase Regular phone communication/coordination, visits as needed; preparing for the future eventually hand off to hospice

18 SHARP TRANSITIONS PROGRAM: FOUR PILLARS ENSURE EFFECTIVE CARE

19 SHARP TRANSITIONS OUTCOMES: HOSPITAL + ED UTILIZATION

20 SHARP TRANSITIONS OUTCOMES: TOTAL COST OF CARE

21 Q & A

22 Questions About the ACLC? If you have questions about the ACLC please

23 South 700 East suite 700, Salt Lake City, UT 84107