National Landscape of Hospital-Based Palliative Care: Findings from the National Palliative Care Registry Maggie Rogers, MPH Senior Research Associate, CAPC Tamara Dumanovsky, PhD VP Research & Analytics, CAPC July 13, 2017
The National Palliative Care Registry is building a profile of palliative care teams, operations, and service delivery. The Registry is free and open to all palliative care programs across service delivery sites.
The National Palliative Care Registry is a joint project of the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC). CAPC Membership is not required to participate.
U.S. Hospital-based Palliative Care
Registry National Participation
Today s Webinar Topics: Growth in palliative care service penetration Trends in staffing and findings on the most prevalent staffing models today Changes in referral sources, in terms of referring specialists and patient locations Insight on patient demographics and primary diagnosis categories Findings on length of stay and timing of patient visits
Participation, 2016 Trends report on over 3,000 surveys For 2016 findings, 351 completed surveys on adult palliative care programs were included Analyses were limited to: surveys with at least total initial consults answered adult or mixed adult/pediatric palliative care programs Pediatric palliative care programs can find key 2016 findings in our upcoming July blog post in CAPC s Palliative in Practice
Key Findings from the Registry
Palliative Care Service Penetration Palliative care service penetration is the percentage of annual hospital admissions seen by the palliative care team. Total number of annual hospital admissions Total number of patients who received a palliative care consult Penetration is used to determine how well palliative care programs in hospitals are reaching patients in need.
Palliative Care Service Penetration 6.0 Mean Penetration Median Penetration 5.0 4.8 5.0 4.4 4.0 3.5 4.0 3.0 2.6 2.7 2.8 3.1 2.0 1.0 0.0 2008 2009 2010 2011 2012 2013 2014 2015 2016
Palliative Care Penetration, 2016 8.0 343 average initial consults 6.8 6.0 718 average initial consults 4.8 1,274 average initial consults 4.0 3.8 Mean Penetration Median Penetration 2.0 0.0 <150 beds (n=67) 150-499 beds (n=202) 500+ beds (n=82)
Palliative Care Staffing, 2016 Physician (MD/DO) Advanced Practice Registered Nurse Social Worker Chaplain Registered Nurse 51% 69% 66% 80% 88% Core Palliative Care Interdisciplinary Team (IDT) Administrator (non-clinical) 36% Medical Director 34% Support Staff 32% Pharmacist 14% Fellow 12% Hospice Liaison 8% Nutritionist 7% Ethicist 6% Physical & Occupational Therapist 5% Music/Art Therapist 4% Resident 4% Child Life Specialist 3% Massage Therapist 3% 0% 20% 40% 60% 80% 100% Percentage of Programs with Discipline on Their Team
Staffing Recommendations Standards set by the Joint Commission Advanced Certification for Palliative Care state that the core interdisciplinary team (IDT) should include, at a minimum: Physician Advanced Practice or other Registered Nurse Social Worker Chaplain 50% 44% 39% 37% 41% 41% 31% 31% Percentage of programs reporting a full IDT 2009 2010 2011 2012 2013 2014 2015 2016
Staffing Recommendations, 2016 Percentage of programs reporting a full IDT, by hospital size: 100% 80% 60% 40% Larger hospitals are somewhat more likely to meet staffing recommendations 63.6% 20% 42.4% 46.5% 0% <150 beds 150-499 beds 500+ beds
IDT Full-Time Equivalent 10.0 <150 beds 150-499 beds 500+ beds Mean Full-time Equivalent (FTE) 8.0 6.0 4.0 2.0 3.8 2.7 2.1 7.6 3.7 2.2 0.0 2009 2010 2011 2012 2013 2014 2015 2016
All Staff Full-Time Equivalent 10.0 <150 beds 150-499 beds 9.4 Avg +1.8 FTE beyond IDT 500+ beds 8.0 Mean Full-time Equivalent (FTE) 6.0 4.0 2.0 4.4 3.0 2.8 4.4 2.7 Avg +0.7 FTE beyond IDT Avg +0.5 FTE beyond IDT 0.0 2009 2010 2011 2012 2013 2014 2015 2016
IDT FTE by Hospital Size 8.0 7.6 7.0 6.0 Mean Full-time Equivalent (FTE) 5.0 4.0 3.0 2.0 2.1 2.2 2.7 3.7 3.8 1.0 0.0 2009 2016 2009 2016 2009 2016 <150 Beds 150-499 beds 500+ beds
IDT FTE by Hospital Size 8.0 7.0 Across hospital sizes, much of the growth in pal care IDTs is attributable to an increase in APRNs 1.2 Mean Full-time Equivalent (FTE) 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Growth in physician, chaplain, and social worker staffing was primarily limited to larger hospitals where each discipline more than doubled 0.4 0.3 0.5 0.4 0.3 0.2 0.5 0.7 0.4 0.3 0.6 0.7 0.6 0.4 0.6 1.2 0.5 0.5 0.7 0.9 2009 2016 2009 2016 2009 2016 0.6 0.3 0.6 1.0 1.3 0.6 1.0 2.3 2.5 Social Worker Chaplain RN APRN Physician <150 Beds 150-499 beds 500+ beds
Relationship between IDT Staffing and Penetration, 2016 7.0 6.0 5.0 Palliative care programs with more than 3.0 interdisciplinary team FTE per 10,000 admissions have a penetration rate nearly double that of programs in the smallest IDT FTE group (less than 1.5 FTE per 10,000 admissions). 4.7 6.6 4.0 3.4 4.1 3.0 Mean Penetration Median Penetration 2.0 1.0 0.0 < 1.5 1.5-2.0 2.1-3.0 >3.0 Interdisciplinary Palliative Care Team FTE per 10,000 Hospital Admissions
Patient Demographics Patient Age 0.3 5.5 22.0 22.9 Less than 18 years old 18-44 years old 45-65 years ago 65-85 years old Over 86 years old For participating programs, nearly half of all patients were between the ages of 65 and 85 years old. 48.7 Patient Ethnicity 1.2 2.5 4.3 2.7 13.3 Black/African American White/Caucasian (Non-Hispanic) Asian American Indian/Alaska Native Hispanic/Latino For participating programs, over three-quarters of patients were non-hispanic White/Caucasian. 75.6 Other
Primary Diagnosis Category, top 7 30% 20% 27% For participating programs, on average, one in four palliative care patients had a primary diagnosis of cancer. 13% 12% 10% 8% 6% 6% 5% 0% Cancer Cardiac Pulmonary Neurological Infectious Complex Chronic Dementia
Top 4 Referrals, 2016 Referring Sites Oncology Unit 8% Step-down Unit 13% Intensive Care Unit 26% Medical/Surgical Unit 43% 0% 20% 40% 60% Referring Physician Specialties Oncology Pulmonary/Critical Care Internal/Family Medicine 7% 12% 12% Hospital Medicine 53% 0% 20% 40% 60% Mean % of Patients Referred from
Changes in Top Referrals Sources Hospitalist Referrals Med/Surg Referrals 60 50 51.0 52.2 55.6 48.9 53.5 42.1 43.5 45.7 41.0 42.8 40 30 20 10 0 2012 2013 2014 2015 2016 2012 2013 2014 2015 2016 Referring sites and referring physician specialties have not really changed since 2012. Palliative care patients are still being referred by the same sites and the same specialties.
Program Features, 2016 29% 43% 49% 73% of programs use standardized screening criteria (trigger) to identify potential pal care patients of programs provide 24/7 coverage, with Monday-Friday inpatient consultation and 24/7 telephone support of programs reported getting custom palliative care reports from their Electronic Health Record (EHR) of programs reported having a quality improvement (QI) plan in place
Length of Stay, Discharged Alive(79%), 2016 Time to Consult Consult to Discharge 500+ beds 5.8 6.8 300-499 beds 5.0 5.2 150-299 beds 4.3 5.0 <150 beds 2.9 4.2 0.0 5.0 10.0 15.0 Total Days
Length of Stay, Died in Hospital (21%), 2016 Time to Consult Consult to Discharge 500+ beds 7.5 5.3 300-499 beds 5.8 4.7 150-299 beds 5.2 4.6 <150 beds 3.5 4.5 0.0 5.0 10.0 15.0 Total Days
Response & Engagement, 2016 31% 68% 6% of patients received a palliative care consult within 1 day of hospital admission of patients received a palliative care consult within 1 day of referral of referred patients were not seen by the palliative care program prior to hospital discharge or death
Discharge Locations, 2016 50.0 47.0 40.0 One-third of patients discharged home received hospice 30.0 25.9 20.0 13.7 10.0 6.4 7.1 0.0 Home (including home hospice & assisted living) Skilled Nursing Facility Inpatient or Residential Hospice Long-term Acute Care, Rehab or General Hospital Other or Unknown Locations
Coming Soon to a Community near You! National Palliative Care Registry reports for the expanded surveys on community-based palliative care programs Make your Mark with Mapping Community Palliative Care, CAPC s new initiative to identify all community-based palliative care programs across the country
National Palliative Care Registry Website: registry.capc.org Email: registryhelpdesk@capc.org Phone: 212-201-2689 The Registry is FREE and open to all palliative care programs. CAPC Membership is NOT required to participate. Pediatric Blog will be available here: https://palliativeinpractice.org/