Palliative Care in the Rural Vacuum

Topic: Measuring Impact and Value

Palliative medicine consultation is associated with improved quality of life with reduced length of hospital stay and health care expense. Palliative medicine services are increasingly available in urban hospitals or facilities with a bed capacity greater than 200. Smaller, typically rural, hospitals often lack the depth of multidisciplinary resources to provide an inpatient palliative medicine service. The purpose of this research is to assess the need for palliative medicine service in rural hospitals without a program and examine for a palliative care impact on hospital readmission rates. Three rural hospitals without a palliative consult program and three tertiary care centers with palliative consult programs were selected. Data was obtained from the Pennsylvania Cost Containment Counsel. Inclusion criteria was admission or readmission for a patient with a diagnosis appropriate for palliative medicine consultation. Methodology included a quantitative analysis of the number of patients admitted in the last quarter of 2014 through 2015 who were appropriate for palliative care consultations. The Chi-square test and Fisher's exact test were utilized, when appropriate, for correlational analysis of rates of readmission between hospitals with palliative medicine services and those without.

Data support the existence of an unmet need for palliative consult services in the rural Pennsylvania hospitals studied. There was a higher rate of readmissions at the non-palliative hospitals 71.6% versus 55.1% (p). Findings from this research may be influential in supporting the creation of palliative telemedicine programs to reach rural institutions lacking palliative consult services. Recomendations include pilot program development of a palliative telemedicine consult program.

Author

  • Craig C. Durie, DNP
  • Nurse Practitioner
  • Lehigh Valley Health Network: OACIS
  • 1255 S Cedar Crest Blvd Suite 3500
  • Allentown, PA 18078
  • (610) 402-8106

Co-authors

  • Catherine Tanksley-Bowe, DNP, MBA, MSN, CNM, RN

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