Health System Strategies

Field of Dreams: Rapid expansion of PC in a Health System

“Build it and they will come”… Starting a program in a single hospital within a healthcare system has challenges, but spreading PC (Palliative care) across a diverse healthcare system is another level of challenge on a wide scale level. When quality programs begin having outcomes that gain executive level attention, it becomes evident that there is a price to not growing PC programs. We sought to expand PC services across our ten hospital health system after demonstrating outcomes at one site. Our staffing model includes a standard transdisciplinary team model of physician, nurse practitioner, clinical pharmacist, social worker and chaplain at each site. Within two years, our program grew from 4 hospitals to all ten having programs demonstrating valuable outcomes, sharing best practices, leveraging research projects and working together through discipline-specific clinical councils. This data will reflect the growth over three fiscal years of having a system wide PC service and describe the model for benchmarking quality measures. Overall, our programs have an average of 32% reduction in daily charges compared with pre-PC daily charges. This represented an average decreases in daily charges in the following categories: 33% in medication charges, 53% in laboratory charges, 28% in room charges. We demonstrated early PC consultation (≤4 days) was associated a 32% decrease in length of stay compared to patients with severe/extreme risk of mortality and severity of illness with palliative care coding. Readmission data will be presented per hospital and represent a range of impacts on 30 day all cause readmission compared to other patients with severe/extreme risk of mortality and severity of illness in the hospitals. Penetration and benchmarking for each hospital will be presented.

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