Universal Access to Palliative Care

Transcription

1 Universal Access to Palliative Care Konrad Fassbender, PhD. Scientific Director, Covenant Health Palliative Institute Division of Palliative Care Medicine, University of Alberta Monday December 8, 2014 Sheraton Wall Centre, Vancouver, BC

2 Covenant Health Palliative Institute Joseph Sanabria

3 Vision Alleviation of suffering for patients and their families through excellence in palliative and end of life care.

4 Mission Enable optimal palliative and end of life care by leading and facilitating research and innovation that supports the translation of evidence into policy and practice, and by increasing awareness and understanding of palliative and end of life care among the public, providers, researchers and government.

5 Core Activities Research Support: support the generation of research in PEOLC topics and the translation of research findings into policy and practice. Education: advance the education of health care providers in PEOLC by providing tools and training opportunities, and by promoting integration of PEOLC material into curricula. Clinical Support: support providers to improve the quality and comprehensiveness of PEOLC services in Covenant Health. Administrative and Policy Support: provide resources and expertise to enhance development, implementation and evaluation of PEOLC programs in Covenant Health. Public Outreach and Engagement: enhance public awareness, education and support in PEOLC.

6 Lord Kelvin, British physicist on numbers and knowledge When you can measure what you are speaking about, and express it in numbers, you know something about it... Copyright Reserved, Konrad Fassbender PhD, 2014.

7 Palliative Care: Something New or Something Old? A century ago, care to the dying was largely administered in the home by the family, neighbours, friends sometimes with the support of a visiting family doctor. Proliferation of hospitals and access to national health insurance resulted in the medicalization and institutionalization of dying. Technological innovation supported this process and resulted in an ever-increasing knowledge gap between physicians and their patients.

8 Access to Palliative Care Unfortunately only 16-30% of Canadians receive palliative care as part of their life-threatening illness. Crown Expert, Carter v Canada 2012 fewer than 30% of the Canadians who will die in 2014 will have access to palliative care. Canadian Medical Association National Dialogue on EoL Care A 2014 study of Canada, England, Germany, and the United States stated that the hospice palliative care utilization rate was 16%-30% of all deaths. Jocelyn Downie and Georgia Lloyd-Smith. Debunking the Myth About Access to Palliative Care. September 30, Impact Ethics.

9 The Grey Tsunami

10 Sisyphus Syndrome 1. Allocate public resources to health. 2. Longevity is enhanced resulting in accelerated ageing of the population. 3. Increased population beyond retirement results in decreased government revenues. 4. Increased demand for health and public resources by seniors. 5. Allocate more public resources to health. The Sisyphus Syndrome in Health Revisited. Peter Zweifel and Lukas Steinmann, Socioeconomic Institute, University of Zurich, Switzerland. June 12, 2002.

11 Deinstitutionalization Hypothesis In 1983 J Watson chaired the CMA Task Force on Health Care Resource Allocation Disproportionate number of elderly Canadians receive institutional care Excessive use of medical technologies driven by motives such as protection from litigation Differences in knowledge of care options by elderly individuals lead to poor decisions Recommend development of community services for elderly with goals of reducing institutionalization, improving quality of life and lowering costs Copyright Reserved, Konrad Fassbender PhD, 2003.

12 "Everything should be made as simple as possible, but not simpler.

13 Functional index Trajectory of Death Trajectory of death Sudden death Terminal illness Organ failure Frailty Month before death Lunney et al. JAMA 2003;289(18):

14 Trajectory of Death

15 Alberta EOL Trajectory Study

16 Total Expenditures '000s Alberta EOL Trajectory Study $12 $10 $8 $6 $4 $2 $ Sudden Death Terminal Illness Organ Failure Frailty

17 Cause of Death Western Canada CIHI Study

18 Cancer Deaths Canadian Cancer Society

19 Place of Death Canadian Cancer Society

20 Place of Death Western Canada CIHI Study

21 Number of People Percent Why is place of death hard to measure? Figure 5: Probability of Receiving Care at Various Settings as a Function of the Last 365 Days Location Before Death, the last /00, days before death n= (1999/00) n= 2549 TPCU Acute Hospice LTC Palliative Home Care Home Days before death

22 Health Service Use Canadian Cancer Society

23 SK Health Service Costs Canadian Cancer Society AB AB, MN, ON, QB, NS ON 23

24 Caregiver Conscription Conspiracy What about the family? While home death is often desired, achieving a home death requires a great commitment from both palliative care programs and the family. The public supports care in the home and other forms of community-based care but does not react well to being conscripted into [unpaid] caregiving. (National Forum on Health 1997:19) 24

25 PEOL $: Family /Caregiver Perspective 25

26 Percentage "Yes" (%) Public polls - increasing ACP engagement Alberta 2007 vs % 80% 70% HQCA 2007 ACP CRIO % 50% 40% 30% 20% 10% 0% Heard of ACP? Recognize ACP defini on? Discussed with family/friends? Discussed with HCP? Have wri en ACP? Have a wri en Personal Direc ve? ACP Element

27 Innovative Models of Palliative Care Service Delivery Interdisciplinary Comprehensive Edmonton July 1995 Calgary Fraser Health 1996 Integrated Coordinated

28 Canadian Palliative and EOL Frameworks

29 Evaluating Integrated, Coordinated, Comprehensive, Regional Palliative Care

30 Economic Evaluation of PEOL - Costs Figure 6: Proportion of Time Spent in Various Care Settings in the Year Prior to Death, April 1993 to March COST SAVINGS 30

31 Economic Evaluation of PEOL - Benefits Figure 6: Proportion of Time Spent in Various Care Settings in the Year Prior to Death, April 1993 to March PALLIATIVE HOME CARE RES. HOSPICE 31

32 Implications for Public Inform the public regarding palliative, EOL and hospice care so that they can make informed decisions and advocate for quality. Recognize and support the significant contribution of patients/families to sustaining a community based model of care.

33 Conclusions 1. Integrated palliative care programs in large urban centers are cost-effective. 2. Deinstitutionalization is a valid strategy to help achieve health care reform objectives. 3. Continue to invest in data capture and management in order to generate a strong evidence base upon which to improve decisions. 4. Encourage improvements in research and evaluation of organizational innovations. 5. Resources and policies to encourage investment in innovations for palliative and end of life care.

34 PEOLC Data Laboratory A Palliative and End of Life Care Data Laboratory (PEOLDL) would optimize patient care through enhanced data management, linkage and analysis of administrative and clinical data: 1. Point-of-care data management 2. Data repository and warehouse 3. Performance measurement 4. Operations and policy support 5. Micro-simulator (innovation incubator) 6. Research and evaluation

35 Peter F Drucker, Management Theorist You can t manage what you can t measure.

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