Palliative Care:It s about Living Better! Akshai Janak, M.D. Huntsville Hospital

Transcription

1 Palliative Care:It s about Living Better! Akshai Janak, M.D. Huntsville Hospital

2 If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health. Hippocrates

3 70 Year Old Raw Foodist Looks Just 40

4 World's Oldest Gymnast - Meet The Record Breakers - Guinness World Records

5 What we can do to die well Timothy Ihrig

6 What is Palliative Care? Specialized medical care for people with SERIOUS illnesses. Care is focused on providing relief from the symptoms, pain, and stress of a SERIOUS illness whatever the diagnosis and at ANY stage of illness The goal is to improve quality of life for both the patient and their family.

7 Symptom Prevalence in Advanced Illness. Kelley AS, Morrison RS. N Engl J Med 2015;373:

8 Palliative Care as Compared with Hospice. Kelley AS, Morrison RS. N Engl J Med 2015;373:

9 It's Part of the Same Spectrum of Care...

10 Old Model of Care

11 The Missing Piece Current Delivery System: Care Gap Stage 4 CHRONIC ILLNESS 2-20 years SERIOUSLY ILL months HOSPICE 6 months or less GRIEF SUPPORT ~ 13 months Tier 3A 5% Medicare Population 50% Medicare Cost

12 New Delivery System Palliative Care Diagnosis Death Stage 4 CHRONIC ILLNESS 2-20 years SERIOUSLY ILL months HOSPICE 6 months or less BEREAVEMENT SUPPORT ~ 13 months CHRONIC ILLNESS CHRONIC ILLNESS CHRONIC ILLNESS SERIOUSLY ILL HOSPICE BEREAVEMENT SUPPORT Palliative Care

13 Current Model EMR Increased dissatisfaction Increased cost

14 Integrated Palliative Primary Decreased cost Decreased dissatisfaction Care Care Med System Better Model

15 The New Model for Medical Care: Palliative Care from the Beginning & Even the End

16 How Can Palliative Care help? It s all about QOL Communicate, listen Teach stress management, coping Use all available resources Support decision making Encourage conflict resolution Help complete unfinished business Urge focus on non illness-related affairs Urge focus on one day at a time Help anticipate grief, losses Help focus on attainable goals Promote physical, psychological comfort Encourage spiritual practices

17 Palliative Care: IDT Physician Nurse Practitioners Chaplain Music Therapist Clinical Pharmacist Social Worker Registered Dietician

18 Referral Criteria A potentially life-limiting or life-threatening condition &... Primary Criteria 1. The surprise question : You would not be surprised if the patient died within 12 mos 2. Difficult-to-control physical or psychological sxs (e.g., >1 admission for same condition w/in several mos) 3. ICU length of stay >/=7 days 4. GOC Lack of clarity & documentation 5. Disagreements/uncertainty among pt, staff, &/or family concerning: major medical treatment decisions resuscitation preferences use of non-oral feeding or hydration

19 Referral Criteria A potentially life-limiting or life-threatening condition &... Secondary Criteria: Awaiting, or deemed ineligible for, solid-organ transplantation Patient/family/surrogate emotional, spiritual, or relational distress Patient/family/surrogate request for palliative care/hospice services Patient is considered a potential candidate, or medical team is considering seeking consultation, for: Feeding tube placement Tracheostomy Initiation of renal replacement therapy Ethics concerns LVAD or AICD placement LTAC hospital or medical foster home disposition bone marrow transplantation (high-risk patients)

20 For Doctors Death isn t failure not knowing your options is.

21 Swinging of the Pendulum Disease Mgt System Fix until death Fee for svc Silo system Health Mgt System Patient Centered Preventive Focus Palliative Approach

22 Vision for future Palliative Care: Huntsville Hospital 1. Consult Service 2. Patient Unit Palliative Care: Outpt 1. Support Clinic 2. Home Service Hospice Services 1. Inpatient Hospice 2. Residential- HFC

23 He, who is born, has to go through childhood, youth and old age. If aging is inevitable, let's be graceful and serene about it and lead a disciplined quality life. -Bhagvad Gita