Cook County (Stroger) Hospital Institution/Program Description

Cook County Hospital is the largest component of the safety net for health care in Chicago and suburban Cook County. The mission statement for the health system is to provide a comprehensive program of quality health care with respect and dignity to the residents of Cook County, regardless of their ability to pay. The Palliative Care Program provides over 500 consultations annually. In a retrospective review of 86 consecutive adult patients seen by the Palliative Care Program from 1/1/08-2/29/08, patients were predominantly minority and ethnically diverse (only 7% were Caucasian-American), young (average age 62 years) and 34% were uninsured. Sixty-three percent of patients were referred for hospice care.

Topic Description

According to 2006 NHPCO hospice statistics, recipients tend to be older, predominantly white and insured. Overall, hospices nationally only provide 1.6% charity care. A Palliative Care Task Force was created to identify palliative care needs and priorities and to create policies regarding palliative care services for the Cook County Bureau of Health System. A hospice subcommittee was formed to identify expectations and develop a system of collaboration with selected community-based hospices. Four hospices were selected based on their commitment to provide the same level of routine home care for all patients, regardless of ability to pay; capacity for a large referral base; shared values to care for diverse patients with Limited English Proficiency; and geographic range of care. The Palliative Care team's commitment to the hospices is to evaluate the appropriateness of hospice referral for all hospitalized patients; assess and address all the domains of palliative care in the consultation; and equitably distribute referrals based on insurance status. The hospital provides an initial 30-day supply of medications upon discharge. For patients who do not have primary care providers, the palliative care physician serves as the attending physician for patients referred for hospice to assist with symptom management.

Impact on Program

• We ensure quality care for our patients through good communication and by building strong relationships with our hospice partners.
• Our public health system will reassess inpatient care for uninsured patients through development of an inpatient palliative care unit to reduce the financial burden on the hospices.

Lessons Learned

• Hospice programs committed to serving an inner city, diverse patient population assume a disproportionate burden of charity care.
• It is possible for public hospitals to establish collaborative working relationships with hospices with shared values to provide quality end-of-life care to indigent patients.