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CAPC Palliative Care Discussion Forum
Data Collection and Measurement

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Post Outcomes measurement
Author: palcare24
Date: Oct 7, 2009 3:42 pm
Within my organization I receive many of my consults once the patient's condition warrants hospice care. I am currently working to get staff to refer patients to palliative care much earlier. One of the outcomes I thought would help to demonstrate whether we are achiving earlier referrals is to compare patient discharge dispositions. If we have greater numbers of palliative care patients discharging to SNF, rehab, or home with home health care that could indicate we are recongnizing patients earlier in their disease trajectory. Those patients who are not ready for hospice would transfer to a skilled facility or rehab to improve/maintain the function they have left if that is identified as part of their goals for care. Does anyone have any feedback on whether they agree/disagree with using this as an outcomes measure? Thanks.
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Re:Outcomes measurement (by kkerr on 10/09/2009)
Hello,
What an interesting question. So you plan to monitor changes in discharge disposition, using the assumption that an increase in the proportion of patients discharged to SNF or rehab or home health and presumably a decrease in the proportion discharged to hospice would indicate that more patients are being referred before they are hospice eligible. I guess I would just worry about other reasons why your discharge disposition distribution would change … did hospice become less available for some reason, either because of changes in how it is presented as an option or from changes in the availability of services, or from changes in the population of patients you serve? I would recommend supplementing your patient level data collection with a simple “Hospice eligible?” Yes/no item … if you have that data point you could say, “Of the 40 patients discharged to rehab, only 10 were hospice eligible, the others were referred earlier in the disease course –a key service goal.” I think that data point would settle concerns that hospice might be underutilized, for whatever reason, in the group of patients who are being discharged to other settings. I’d be interested in what others have to say on this matter.

Best wishes, Kathleen Kerr, Senior Analyst, University of California San Francisco, Palliative Care Leadership Center
+ Re:Outcomes measurement (by jedwa1095 on 11/11/2009)
I am currently working on my DNP and as my facility is building a PC program, I am doing my scholarly project on the referral piece of the program.I would be very interested in the methods used to educate staff on identifying referrals and whether you use the CAPC tool. Also, I am struggling with the measurement methods to ascertain a successful education program focused on referrals. Did your facility educate the physicians or just the nursing staff?
I think you could certainly use discharge dispositions as an outcomes measure especially in light of decreasing cost r/t LOS.

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