Comparative Performance Report

Transcription

1 2013 Hospital Palliative Care Comparative Performance Report Reaching Patients in Need Rutland Regional Medical Center Palliative Care Program 160 Allen Street Rutland, VT Hospital(s) in which Program Operates: Rutland Regional Medical Center

2 Table of Contents Letter from Diane E. Meier, MD, and R. Sean Morrison, MD 3 Introduction 4 Rutland Regional Medical Center Palliative Care Program 2013 Performance at a Glance 5 Structure of the Report 6 Comparing Your Results 7 Peer Group #1: Palliative Care Service Penetration Peer Group Peer Group #2: Hospital Bed Size Peer Group Hospital Palliative Care Comparative Performance Results 9 1. Palliative Care Service Penetration 2. Hospital Palliative Care Staffing 3. Hospital Palliative Care Annual Initial Consult Workload 4. Hospital Palliative Care Patients Length of Stay Appendices 17 A Data Sources B Definitions C Resources D History and Funding Sources Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 2

3 Letter from Diane E. Meier, MD, and R. Sean Morrison, MD We are pleased to release the 2013 National Palliative Care Registry results. The Registry tracks the structures and processes of U.S. palliative care teams for peer comparison and longitudinal tracking of performance over time, providing information on the scope and variation of hospital palliative care programs. Palliative care focuses on improving quality of life for the nation s sickest and most vulnerable patients and their families. A growing evidence base demonstrates that palliative care improves quality of life, quality of care, patient and family outcomes and, in several studies, survival. As a consequence of better quality of care and the clear decisions and care plans that result, patients are spared unnecessary and burdensome treatments. Care aligned with what matters most to patients and their families results in consistently lower costs both to hospitals and to payers. The Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC) jointly developed the National Palliative Care Registry in an effort to track and describe this growth and to support standardization and quality of palliative care services. The Registry is a valuable resource for policy makers and payers seeking to understand the scope and variation of access to palliative care teams nationwide, and a quality improvement tool for individual programs and health systems. The 2013 Hospital Palliative Care Comparative Performance Report provides comparative metrics on palliative care patient volume as a proportion of annual hospital admissions (a measure of penetration); staffing levels and ratio of staff to patient volume (a measure of workload); and the impact of staffing levels on hospital length of stay (a measure of impact and access). Year-by-year comparisons permit tracking of program growth and impact. Palliative care programs have used Registry data to make the case for higher levels of staffing to meet patient need; others, including policy makers and payers, have used the data to assess access to palliative care. Key findings from the 2012 and 2013 Registry data include a steady increase in the number and percentage of patients served; a clear association between staffing levels and the ability to reach more patients; and an equally clear association between staffing levels and timeliness of access to palliative care, with the result of significant reductions in hospital length of stay. Between 2012 and 2013, programs reporting data to the Registry reported a higher level of mean penetration (number of consults per total annual admissions) increasing from 3.6% (0.3% to 17.5%) to 4.0% (0.03% to 19.8%). Our thanks go to Registry participants for submitting your individual program data. We welcome your feedback on how the Registry data has served you thus far, and also your suggestions as to what should be amended or added in the future. Your participation is critical to advance the palliative care field, both in your own programs and in health care nationwide. Diane E. Meier, MD R. Sean Morrison, MD Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 3

4 Introduction The purpose of the 2013 Hospital Palliative Care Comparative Performance Report is to provide programs with comparative data that will guide resource allocation and program design to better reach patients in need (see Appendix A: Data Sources for a list of data used in compiling this report). There are two peer groups defined in this report. The first peer group is based on similiar levels of palliative care service penetration; the second peer group is based on hospital bed size (see Appendix B: Definitions for further details on peer group definitions). The metrics provided in this report are used primarily to represent data for your individual program, for peer palliative care programs and for all hospital programs (as aggregate data). The key metrics examined in this report include: 1. Palliative Care Service Penetration Penetration is the ratio of hospitalized patients treated by palliative care teams to annual hospital admissions. This ratio provides an estimate of how well palliative care teams are meeting the needs of a given hospital's inpatient population. For most hospitals, we estimate that 8 percent to 12 percent of admissions would benefit from specialist-level palliative care. Hospitals that provide training in palliative care knowledge and skills to core clinical staff (e.g., ICU teams, hospitalists and oncology service lines) may report lower penetration ratios as frontline teams manage more palliative care needs. The average penetration among all Registry palliative care programs in 2013 was 3.9% with a range of 0.0% to 17.2%. The top 25 percent of palliative care programs in terms of penetration in 2013 reached an average of 7 percent of annual hospital admissions. 2. Palliative Care Staffing Ratios Two ratios help assess the ability of palliative care teams to meet the needs of seriously ill hospitalized patients and their families. Ratios are presented for the palliative care interdisciplinary team as a whole (see Appendix B: Definitions for further details on palliative care staffing ratios). It is important to recognize the interactivity of staffing levels, effectiveness and penetration. Higher staffing levels enable more visibility, timely response and complete followthrough. Larger teams serving more patients are able to achieve some efficiency, as reflected in workload capacity. However, as there continues to be significant variation in patterns of care and the population served, these ratios should not yet be considered benchmarks; rather, they are reference points that may be directionally useful for comparison. Measure of Staffing Levels: Palliative Care Interdisciplinary Funded Team FTE (Full-Time Equivalent) per 10,000 Admissions Measure of Workload: Initial Inpatient Visits per Palliative Care Interdisciplinary Funded Team FTE 3. Hospital Palliative Care Patients' Length of Stay The average patient length of stay (LOS) prior to palliative care consultation is a measure of the timeliness of patient/family needs identification and referral to palliative care. In contrast, hospital LOS after palliative care consultation is a measure of palliative care team efficiency. Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 4

5 Rutland Regional Medical Center Palliative Care Program HOSPITAL PALLIATIVE CARE TEAM 2013 PERFORMANCE SNAPSHOT EXHIBIT 1 Your Palliative Care Program 2013 Team Snapshot Characteristics Your 2013 Snapshot Hospital Palliative Care Service Penetration 11.6% Hospital Palliative Care Service Penetration Peer Group 4th Quartile Total 2013 Hospital Admissions 5,841 Hospital Bed Size 82 Hospital Bed Size Peer Group 50 to 99 beds EXHIBIT 2 Your Palliative Care Program Key Performance Metrics Key Performance Metric Hospital Palliative Care Service Penetration 11.6% 10.8% Total Initial Palliative Care Consults Total Palliative Care Subsequent Visits Unable to Report Unable to Report Interdisciplinary Funded Team FTE Funded FTE Funded FTE Physician (MD/DO) 0 Advanced Practice Registered Nurse (APRN)/Physician Assistant (PA) Chaplain 0 Social Worker (SW)/Psychologist Registered Nurse (RN) Length of Stay (LOS) Pre-palliative care consultation (hospital admission to consult) 3 3 Post-palliative care consultation (consult to hospital discharge) 5 5 Overall (hospital admission to hospital discharge) 8 8 Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 5

6 Structure of the Report The remainder of this report presents comparative findings for 2013 across all peer groups and for your team. It is divided into three sections: Comparing Your Results provides an overview of the characteristics of hospital palliative care programs with active services submitting 2013 operational data to the Registry. The hospitals are separated into two peer groups: (1) levels of palliative care service penetration; and (2) hospital bed size. The 2013 Hospital Palliative Care Program Comparative Performance Results is the comparative performance analysis, which includes a discussion of penetration, staffing, capacity, and measures of timeliness and efficiency. The Appendices provide the data sources, defintions, resources and funding sources for this report. Data are provided for your individual hospital palliative care program; for peer palliative care programs, defined according to similar levels of palliative care service penetration and hospital bed size; and aggregate data for all hospital palliative care programs that submitted data to the Registry. These data are retrospective (describing 2013 service characteristics) and are intended to provide relative or directional insights, comparative performance results and areas for further analysis. Since palliative care teams conduct a wide variety of activities beyond direct patient care, including public and professional education, research, and administration and management, these workforce capacity and penetration data do not represent a definitive benchmark or performance target. Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 6

7 Comparing Your Results 374 hospital palliative care teams in the U.S. with active services submitted data about their 2013 palliative care operations to the National Palliative Care Registry. This report provides a review of your hospital palliative care team s performance as compared to that of your peers. Palliative care service penetration peer groups are defined in this report as hospital palliative care teams with similar levels of palliative care service penetration. Penetration is defined as the ratio of the number of palliative care patients seen to the total of annual hospital admissions. Palliative care service penetration peer groups are divided into quartiles, with each quartile representing approximately 25 percent of respondents. The quartiles, or four peer groups, are numbered from lowest to highest penetration: Quartile 1: 0 to 25th percentile Quartile 2: 26th to 50th percentile Quartile 3: 51st to 75th percentile Quartile 4: 76th to 100th percentile Exhibit 3 presents comparative hospital palliative care service penetration for active hospital palliative care teams that submitted data for 2013 to the Registry. EXHIBIT 3 Hospital Palliative Care Service Penetration, 2013 (n = 374 hospital palliative care teams) Quartile 4 Quartile 3 Quartile 2 Quartile 1 Range: 4.9% % Range: 3.3% - 4.8% Range: 2.1% - 3.3% Range: 0.0% - 2.1% Your program's penetration of 11.6% places it in the 4th quartile. Use this grouping to compare your hospital palliative care team results with those of your palliative care service penetration peer group. Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 7

8 Peer groups based on hospital bed size are defined as follows: Less than 50 beds 50 to 99 beds 100 to 199 beds 200 to 299 beds 300 to 399 beds 400 to 499 beds 500+ beds Compare your palliative care team results to those of hospitals of similar sizes. Keep in mind that the results provide only a relative indication of how your palliative care team performance compares to other hospital palliative care teams. Although in some cases the most useful comparison may be to aggregate data from all respondents, grouping data by hospital bed size may help to interpret raw numbers such as FTEs. Exhibit 4 presents the hospital size peer groups and percentage of programs that submitted data to the Registry within each group. EXHIBIT 4 Registry Participation by Hospital Bed Size, 2013 (n = 374 hospital palliative care teams) n = 30 n = 39 n = 101 n = 79 n = 45 n = 26 n = 54 Your program's hospital bed size of 82 places it in the 50 to 99 bed size category. Use this grouping to compare your hospital palliative care team results with those of your hospial bed size peers. Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 8

9 2013 Hospital Palliative Care Comparative Performance Results This report provides comparative analyses of your hospital palliative care team performance and that of your peer groups in terms of palliative care service penetration status and hospital bed size. PALLIATIVE CARE SERVICE PENETRATION Hospital palliative care penetration tracks palliative care patient consult volume as a percentage of annual hospital admissions. Multiple factors influence hospital palliative care service penetration, including: Program age It may take several years for palliative care teams to reach steady-state patient volume. Resources Adequately staffed teams with appropriate administrative infrastructure are likely to have higher patient volumes, to provide more efficient care, and to be embedded in hospital care workflow and delivery systems. Exhibits 5 and 6 compare hospital palliative care penetration for 2013 across all peer groups, relative to your palliative care program. EXHIBIT 5 Mean Hospital Palliative Care Service Penetration (by Palliative Care Service Penetration Quartile) Median Palliative Care Service Penetration (by Quartile Peer Group) 6.7% 4.0% 2.7% 1.4% 3.3% Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 9

10 EXHIBIT 6 Mean Hospital Palliative Care Service Penetration (by Hospital Bed Size Peer Group) Median Palliative Care Service Penetration (by Bed Size Peer Group) 4.2% 5.5% 3.3% 3.2% 3.5% 3.2% 3.0% 3.3% Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 10

11 HOSPITAL PALLIATIVE CARE STAFFING The balance between staffing and workload is characterized by two ratios reflecting the ability of palliative care teams to meet the needs of seriously ill patients. An effective team has the staff capacity to act quickly; to spend time with patients and their families in order to best resolve issues; and to support communication, coordination and care needs beyond billable service definitions. Palliative Care Interdisciplinary Funded Team FTE per 10,000 Hospital Admissions is a measure of staffing levels. This ratio is presented for the team as a whole. The formula for measuring workload is initial Inpatient Visits per Palliative Care Interdisciplinary Team FTE. STAFFING: INTERDISCIPLINARY PALLIATIVE CARE TEAM - FUNDED FTE PER 10,000 ADMISSIONS Exhibits 7 and 8 present 2013 data on mean team staffing results across all peer groups, relative to your palliative care program. EXHIBIT 7 Mean Palliative Care Staffing per 10,000 Hospital Admissions (by Palliative Care Service Penetration Quartile) Median Palliative Care Staffing (Interdisciplinary Funded FTE per 10,000 Hospital Admissions) Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 11

12 EXHIBIT 8 Mean Palliative Care Staffing per 10,000 Hospital Admissions (by Hospital Bed Size Peer Group) Median Palliative Care Staffing (Interdisciplinary Funded FTE per 10,000 Hospital Admissions) Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 12

13 HOSPITAL PALLIATIVE CARE ANNUAL INITIAL CONSULT WORKLOAD When reviewing comparative consult volume ratios, it is important to remember that there remains wide variation in terms of the practice settings, the content of palliative care work, and the support mechanisms for palliative care, which may or may not be reported as palliative care funded FTEs. For example: Programs with a critical mass of staff and with larger consult volume may be able to achieve efficiencies and higher rates of consults per FTE. Programs with variations in terms of patient and referral mix may also drive significant differences in the number of patients served per FTE. Whether out of necessity or preference, some programs function solely with individual clinicians seeing patients, rather than routinely including interdisciplinary staff. This may result in higher consults per FTE, but not necessarily in more effective care or in lower costs per consult, when compared to programs that utilize the full interdisciplinary team. Academic medical centers, teaching hospitals or palliative care teams that devote significant effort to high-impact activities such as research, teaching, innovative program design, committees or other leadership work, telemedicine or community outreach may report lower consults per FTE, while creating value in other ways. Smaller hospitals with high consult volume and penetration may achieve efficiency through geographic proximity, which allows for more frequent consults and therefore continuity in relationships with attending staff. Hospitals with dedicated in-patient palliative care units may have additional efficiencies. These examples reinforce the point that the comparative data are for reference only, and are not to serve as either benchmarks or goals. We encourage teams to track these numbers, understand what factors influence them and set goals related to customized context. We also want to highlight the importance of collecting accurate data on both consult volume and subsequent visits, and we encourage thorough reporting of these data to the National Palliative Care Registry. Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 13

14 PALLIATIVE CARE SERVICE - ANNUAL INITIAL CONSULT WORKLOAD RESULTS Exhibits 9 and 10 present 2013 data on mean annual team workload results across all peer groups, relative to your palliative care program. EXHIBIT 9 Mean Annual Initial Inpatient Visits per FTE (by Palliative Care Service Penetration Quartile) Median Initial Inpatient Visits per FTE Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 14

15 EXHIBIT 10 Mean Annual Initial Inpatient Visits per FTE (by Hospital Bed Size Peer Group) Median Palliative Care Staffing (Interdisciplinary Funded FTE per 10,000 Hospital Admissions) Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 15

16 HOSPITAL PALLIATIVE CARE PATIENTS LENGTH OF STAY Average length of stay (LOS) before palliative care consultation is an indicator of the timeliness of palliative care delivery to patients in need. Shorter LOS between admission and palliative care services may reflect use of trigger systems or checklists to proactively identify patients with palliative care needs earlier in their hospital stay, or higher integration of palliative care team members on units and in daily rounding. Note: Exhibits 11 and 12 present the mean LOS for all palliative care inpatients in 2013 (whether discharged alive or dead) across all peer groups, relative to your palliative care program. EXHIBIT 11 Average Length of Stay by Palliative Care Service Penetration Quartile Average Length of Stay (LOS) Quartile 4 Quartile 3 Quartile 2 Quartile 1 All Your Team Pre-palliative care consultation (hospital admission to consult) Post-palliative care consultation (consult to hospital discharge) Overall (hospital admission to hospital discharge) EXHIBIT 12 Average Length of Stay by Hospital Bed Size Peer Group Average Length of Stay (LOS) Less than All Your Team Pre-palliative care consultation (hospital admission to consult) Post-palliative care consultation (consult to hospital discharge) Overall (hospital admission to hospital discharge) Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 16

17 Appendices Appendix A: Data Sources Appendix B: Definitions Appendix C: Resources Appendix D: History and Funding Sources APPENDIX A: DATA SOURCES The primary data source for this report is the information reported by palliative care teams to the 2013 National Palliative Care Registry. Data from the American Hospital Association (AHA) Annual Survey Database were used as a secondary data source when data were not available or not entered in the National Palliative Care Registry for total annual hospital admissions and total hospital beds. APPENDIX B: DEFINITIONS This section provides explanations for terms commonly used throughout this report. Annual Hospital Admissions The total number of hospital admissions for a given year (excludes obstetric, psychiatric and rehabilitation admissions). Full-Time Equivalent (FTE) The FTE is the percentage of time (as a decimal) that a team member dedicates to direct patient care as part of the palliative care service. A single member s full-time care is represented as 1.0 FTE ; half-time care as 0.5 FTE ; and quarter-time care as 0.25 FTE. Hospital Palliative Care Service Penetration This ratio of palliative care consults to annual hospital admissions is a measure of palliative care service penetration or the depth of palliative care service integration. Initial Palliative Care Consults The total number of inpatient initial consults seen by the palliative care team. Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 17

18 Length of Stay (LOS) LOS is the duration of a single episode of hospitalization. LOS prior to palliative care consultation is a measure of the timeliness of patient/family needs identification and referral to palliative care. Hospital LOS from the time of palliative care consultation to the time of hospital discharge is a measure of palliative care team efficiency. Measure of Initial Workload Initial Inpatient Visits per Palliative Care Interdisciplinary Team FTE Measure of Staffing Levels This ratio is a measure of the hospital palliative care team staffing FTE that is available to meet patient needs per 10,000 hospital admissions. Palliative Care Interdisciplinary Team Members of the palliative care interdisciplinary team include physicians, advanced practice registered nurses and/or physician assistants, social workers and/or psychologists, chaplains and registered nurses. Peer Group There are two peer groups defined in this report. The first peer group is based on similar levels of palliative care service penetration, and the second peer group is based on hospital bed size. Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 18

19 APPENDIX C: RESOURCES A National Framework and Preferred Practices for Palliative and Hospice Care Quality: A Consensus Report. National Quality Forum; Available at A_National_Framework_and_Preferred_Practices_for_Palliative_and_Hospice_Care_Quality.aspx. Clinical Practice Guidelines for Quality Palliative Care, Third Edition. National Consensus Project for Quality Palliative Care; Available at NCP_Clinical_Practice_Guidelines_3rd_Edition.pdf. The Joint Commission s Quality Check Certification Programs: CertificationList.aspx. The Joint Commission s Advanced Certification for Palliative Care: certification/palliative_care.aspx. Weissman DE, Meier DE: Center to Advance Palliative Care inpatient unit operational metrics: consensus recommendations. J Palliat Med Jan;12(1):21-5. Available at pubmed/ Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the Center to Advance Palliative Care. J Palliat Med Jan;14(1): doi: /jpm Available at online.liebertpub.com/doi/abs/ / jpm Weissman DE, Meier DE. Operational features for hospital palliative care programs: consensus recommendations. J Palliat Med. 2008;11(9): Available at online.liebertpub.com/doi/abs/ /jpm Weissman DE, Meier DE, Spragens LH. Center to Advance Palliative Care palliative care consultation service metrics: consensus recommendations. J Palliat Med Dec;11(10): Available at online.liebertpub.com/doi/abs/ /jpm Weissman DE, Morrison RS, Meier DE. Center to Advance Palliative Care palliative care clinical care and customer satisfaction metrics consensus recommendations. J Palliat Med Feb;13(2): Available at online.liebertpub.com/doi/pdfplus/ /jpm Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 19

20 APPENDIX D: HISTORY AND FUNDING SOURCES The Center to Advance Palliative Care (CAPC) is a national organization devoted to increasing access to quality palliative care for seriously ill individuals and their families. CAPC s mission is to promote best practices and provide comprehensive training and technical assistance for palliative care delivery across the continuum. The National Palliative Care Research Center (NPCRC) is committed to stimulating, developing and funding research aimed at improving care for seriously ill patients and their families. The NPCRC provides an administrative home to promote intellectual exchange, the sharing of resources (e.g., access to biostatisticians) and access to data from ongoing studies to plan and support new research. CAPC and NPCRC receive generous support from a broad array of national foundations, individual philanthropists, and federal and state agencies. Following is a select list of our major funders: Center to Advance Palliative Care (CAPC) Altman Foundation Brookdale Foundation California HealthCare Foundation Cambia Health Foundation Cameron and Hayden Lord Foundation Donaghue Foundation John A. Hartford Foundation LIVESTRONG Foundation Milbank Foundation Mill Park Foundation Olive Branch Foundation Pat and Jay Baker Foundation Stavros Niarchos Foundation The Atlantic Philanthropies The Fan Fox and Leslie R. Samuels Foundation, Inc. Thelma Lyon Y.C. Ho/Helen & Michael Chiang Foundation National Palliative Care Research Center (NPCRC) American Academy of Hospice and Palliative Medicine American Cancer Society Brookdale Foundation Cameron and Hayden Lord Foundation Hearst Foundations Hospice and Palliative Nurses Association LIVESTRONG Foundation Mill Park Foundation National Institute on Aging Pat and Jay Baker Foundation The Atlantic Philanthropies The Emily Davie and Joseph S. Kornfeld Foundation Y.C. Ho/Helen & Michael Chiang Foundation Rutland Regional Medical Center Palliative Care Program 2013 National Palliative Care Registry 20