Characterizing Quality in Inpatient Palliative Care
Topic: Quality Improvement
Background: Over two-thirds of hospitals in the United States have palliative care programs, including 90% of hospitals with 300 or more beds. However, there is little data assessing the characteristics of these programs and how differences in program quality may affect patient care.
Objective: To identify common characteristics of inpatient palliative care programs, and to explore their effects on hospital outcomes.
Methods: Program-specific data from the National Palliative Care Registry were compared with hospital-level outcomes obtained from the Dartmouth Atlas of Health Care (2013-2014). Multivariate logistic regression analyses were used to identify program characteristics that were significantly associated with relevant patient outcomes.
Preliminary Results: Of 219 inpatient palliative care programs (based in US hospitals with 300 or more beds) included in this study, 107 (48.9%) reported staffing a complete interdisciplinary team (as defined by the Joint Commission) and 80 (36.5%) reported high levels of ICU integration. The presence of a complete interdisciplinary team was associated with a 3.23 (p=0.019, 95% CI=0.547-5.916) decrease in the percentage likelihood of an ICU admission and a decrease in mean ICU days (intermediate intensity) from 2.57 to 1.98 (p=0.039, 95% CI=0.030-1.157) in the last 6 months of life. In addition, programs reporting high levels of ICU integration were associated with a 2.83 (p=0.028, 95% CI=0.312-5.355) decrease in the percentage of patients with a primary care visit within 14 days of discharge to home and a 0.58 (p=0.027, 95% CI=0.066-1.085) decrease in the percentage of patients with an emergency department visit within 30 days of discharge to home.
Discussion: The preliminary results suggest that the presence of a complete inpatient palliative care interdisciplinary team and high levels of ICU integration are significantly associated with improved hospital-level outcomes, despite relatively low penetration. The wide range of different staffing and integration models across US palliative care programs suggest a need for further investigation into program quality measures and their potential effects on patient care.
- Ian B. Kwok
- Icahn School of Medicine at Mount Sinai
- 1 Gustave L. Levy Place
- New York, NY 10029
- Ian B. Kwok, BA
- Maggie Rogers, MPH