Virtual Palliative Clinic for LVAD Patients at Home
Topic: Quality Improvement
Background: Given the severity of illness with Left-Ventricular Assist Device (LVAD) implantation, it is clear that LVAD patients seen by the PC team while hospitalized could benefit from more frequent out-of-hospital healthcare interaction. Telehealth can provide a link for these patients to provide clinical support without the burden of transportation and energy requirements for in-person clinic visits. To this end, the Palliative Telehealth Connecting Hospital to Home (PATCH2) Program was created as a “virtual clinic” for advanced heart failure patients following hospitalization. This represents a case study of the first LVAD patients to enroll in this program.
Objective: To describe the impact of telehealth visits on the post-hospital care of a cohort of LVAD patients with palliative needs. Methods: Patients with LVADs and receiving PC consultation with a discharge plan to home, between January and March 2016, provided informed consent, randomized and enrolled to tablet or telephone groups for follow up. Patients were excluded if they could not report their own symptoms, or did not speak English. Both groups of study patients will receive PC follow up meetings from the PC clinical pharmacist and social worker (via video conference or phone call) post discharge at 2-5, 15, 30, and 60 days. Recommendations and updates are communicated to the primary medical teams. Patients in both groups completed surveys to report symptoms, quality of life, satisfaction with care, communication, and medication adherence. Tablets will also provide patients with updated medication lists, and targeted education. This study was approved by MedStar Health IRB.
Results: To date, this case series includes the first five patients to complete the first month in the PATCH2 program (2 tablet, 3 phone). Eleven patients were enrolled, however 6 had barriers to participation: not able to reach patient (3/11), readmitted to subacute rehabilitation/hospitalizations (2/11), and one requested removal from program before initial contact. The case study patients (n=5) had a mean age of 59 years (range 46-70), 3/5 were male and 3/5 were African American. Two patients were enrolled during the index admission for LVAD implantation. The reasons for PC consultation were pain (2/5), non-pain symptoms (2/5), DT-LVAD evaluation (1/5), and goals of care (1/5). For this session, an updated series summary of patient demographics, clinical interventions made during PATCH2 visits along with responses reflecting symptom scores, satisfaction with care, and quality of life will be presented.
Conclusions: Patients with heart failure requiring an LVAD have potential to benefit from prolonged palliative care interactions. A model for palliative care telehealth visits is described, as well as challenges related to engaging patients.
- Andre D'Souza
- Research Coordinator
- Medstar Washington Hospital Center
- 110 Irving Street NW
- Washington, DC 20010
- Andre D'Souza – Research Intern
- Hunter Groninger, MD
- Kathryn Walker, PharmD
- Nicole Graham, PharmD
- Renee M. Holder, PharmD
- Selma Mohammed, MD