PATCH2 Program, The Creation of a Virtual Palliative Care Clinic

Topic: Leveraging Technology

Background: We often lose touch with our patients after spending a lot of time connecting with them during their hospital stay. To prevent this lapse in care, we will describe how we harnessed the power of video conferencing and mobile technology to redefine the boundaries of our team and provide effective, efficient patient care outside the walls of our community teaching hospital. This project represents collaboration between palliative care, home health and telehealth to extend palliative care outside the walls of the hospital to provide continuity of care. Through the smart and appropriate use of mobile technologies we aimed to improve patient/provider communication, facilitate a comprehensive approach to medication management, and enhance patient self-care education in a target population of urban-dwelling patients with advanced heart failure admitted to one of four participating hospitals.

Methods: Patients are approached for consent if a PC consultation is ordered by the attending physician, the patient has a diagnosis for advanced COPD or heart failure (stage C or D), and the patient is planned to be discharged home. Once consented, the patients are randomized (2:1) to receive PC follow up after hospital discharge through either an internet-equipped electronic tablet or telephone. Patients who do not wish to be enrolled in the study receive normal follow up post discharge and data for this group will be collected through a retrospective chart review to compare readmission rates between groups. Both groups of study patients receive PC team follow up meetings (via video conference or phone call) post discharge at 5, 15, 30, and 60 days. Patients self report symptoms, quality of life, satisfaction with care, communication, and medication adherence using surveys. Tablets also provide patients with updated medication lists, targeted education, and a recording of their family meeting to review with family members. Primary outcomes will include 30 day readmission data compared to 30 days pre-program enrollment and medication interventions. Medication interventions are reported as patient safety events prevented and categorized using NCC MERP (National Coordinating Council for Medication Error Reporting and Prevention) scale.

Results: Sixty patients were enrolled during the first 18 months with an average age of 60 years (range 30-91). Compared to pre-PATCH2 enrollment, hospital admissions were decreased by 60%. Medication interventions were categorized as patient safety events prevented and 9% would have reached the patient and caused harm, 53% would have reached the patient and required additional monitoring/intervention, and 13% would have reached the patient without harm.

Author

  • Kathryn A. Walker, PHARMD
  • Senior Clinical and Scientific Director of Palliative Care, Associate Professor
  • MedStar Health
  • 201 E. University Pkwy, 33rd St Bldg
  • Baltimore, MD 21218
  • (410) 375-3699

Co-authors

  • Andre D'Souza – Research Intern
  • Christopher Kearney, MD
  • Dave Brennan
  • Hunter Groninger, MD
  • Kasey Malotte, PharmD
  • Leigh Cervino – Pharmacy Student
  • Nicole Graham, PharmD
  • Renee Holder, PharmD

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