To prevent and relieve suffering, and promote quality of life at every stage of life
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1 To prevent and relieve suffering, and promote quality of life at every stage of life
2 Overview & International Programs Frank D. Ferris, MD, FAAHPM, FAACE Institute for Palliative Medicine at San Diego Hospice University of California San Diego University of Toronto
3 San Diego County 11,721 km 2 = 4,526 sq miles County = 3.1 million City = 1.25 million
4
5 San Diego County Mortality ,408 deaths 24.5 % Heart disease 24.3 % Cancer 5.9 % Alzheimer s disease 5.8 % Cerebrovascular disease 5.4 % Chronic Lower Respiratory disease 4.8 % Accidents
6 Palliative Care Therapies to modify disease End-of-life Care Non-Hospice Palliative Care Hospice Care Presentation Therapies to relieve suffering and / or improve quality of life 6m Death Bereavement Care
7 Medicare Hospice Benefit Capitated Daily Funding Since 1982 Routine care $140 / day Respite care $140 / day ( 5 days ) Inpatient care $800 / day ( costs $1200-$1400 ) Continuous / crisis care $800 / day
8 Medicare Hospice Benefit Covers Interdisciplinary team care Nurse Medical counselor ( advanced degree ) Spiritual counselor Medication / therapy related to terminal diagnosis Equipment Supplies Volunteer Other services as needed
9 Hospices in San Diego County 16 hospices 10 Not-for-profit 6 For-profit
10 San Diego Hospice Founded Dr. Doris Howell Community-owned Not-for-profit Academic Education Research Advocacy Campus 1991 Gift of Joan Kroc
11
12 Beliefs
13 San Diego Hospice ( SDH ) 800 staff 700 volunteers Budget $82 million Hospice Care Prognosis < 6 months 4,500 new patients per year Non-Hospice Care Any time 1,500 new consults per year
14 SDH Hospice Care Avg. Census > 1,000 patients / day Home care 9 branches / d Long-term care 4 branches / d 3 Acute inpatient units 36 beds Pediatric team / d Ambulatory outpatient clinic Team 7 Px < 7 days Triage Nurses Extended care nights, weekends
15
16 SDH Non-Hospice Care 4 hospital-based consult services each seeing 5-15 / day UCSD Cancer Center La Jolla UCSD Hillcrest Scripps Mercy Hospital Scripps Chula Vista Hospital Ambulatory outpatient clinics AIDS case management 120 / d
17
18 SDH Integrative Palliative Care Acupuncture Aromatherapy Art therapy Dignity therapy Art therapy Hypnotherapy Massage therapy Music therapy Energy therapy
19 Other SDH Clinical Services Palliative medicine providers 17 staff physicians 10 palliative medicine fellows 6 nurse practitioners Wound care Ethics consults Palliative care psychiatry 5 psychiatrists 1 psychologist Center for grief care and education > 12,000 / yr
20 SDH Outcomes SDH US ( 2009 ) Avg. length of stay days < 7 days 33 % 34.4 % Median length of stay days
21 Outcomes San Diego County 2008: 19,408 deaths % dying enroll in hospice US 39 % San Diego 70 %
22 Outcomes San Diego vs. Los Angeles San Diego County Los Angeles County Use of Hospice Care Cost of Hospice Care 70 % 25 % 50 % higher than San Diego County Last 2 yrs of life < $29,000 > $43,000
23 To discover, demonstrate and disseminate strategies for palliative care
24 Education
25 US Palliative Medicine Fellowship 2006 ABMS Subspecialty 10 of the 24 parent boards 12 month fellowship, > 57 graduates
26 Education 2010 > 4,000 Trainees
27
28 # of Studies Research IPM - Open Research Studies by Year Complementary Staff Development Medical Records Psychosocial Medical Intervention Bereavement Education 5 0
29 Transforming Healthcare Internationally
30 International Palliative Care Resource Center
31 International Programs Situation analyses Facilitation, strategic planning Education Sensitization lectures In-country courses Expert training Visitors Leaders Program implementation
32 International Visitors Singapore Dover Park & Assisi Hospices Australia Chile Ethiopia Japan Norway Sweden
33 International Physician Fellows
34 22 Participants, 8 Mentors Cohort 1 22 Physicians 8 Mentors Brazil Argentina 2 Czech Republic Slovenia Hungary Moldova Jordan 3 India Nigeria Uganda 2 Kenya Tanzania Botswana 2 South Africa 3 Vietnam
35 Reach Patients Participants Each Lives Presentations > K Courses > K Fellows 11 10, K+ Leaders 22 10, K+ > 1,880 K
36 Questions?
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