Palliative care is high-quality patient care that helps patients with serious illness live better, and often longer. Partners In Care, a non-profit hospice and home health agency, launched a community-based palliative care program in 2014, and over the past 5 years, like many programs, we have had to adapt to changes and reform our program for both financial reasons and to better meet the needs of our community.

At the inception, our palliative care physician was embedded in an oncology practice, and achieved rapid success based on tracked quality metrics, excellent patient and provider satisfaction, and swift growth. However, we still didn't reach many patients who would benefit from palliative care, so partnered with two different primary care practices (one private, one FQHC) by embedding palliative care nurses in these settings. Clinically, this program was extremely effective, with improvement in health outcomes of patients with serious illness as measured by improved quality of life, clarification and communication of patients' medical care goals, and high provider satisfaction. Despite our successes, financially it was unsustainable. In addition, many patients are home-bound or have significant mobility issues, precluding their ability to take advantage of this service, prompting our program to further evolve.

To improve access, we secured grant funding that enables our palliative care nurse to do 300 home visits this year. We continue to partner with these clinics to reach their frailest patients and are also working more closely with our home health service to consult on high-risk patients. In addition, we have a partnership with PacificSource (our local CCO and health insurer); they cover the expense of our palliative care nurse to do palliative care home visits on their appropriate clients. Targeted patients are those felt to be in their last two years of life, patients deemed high risk for crisis, patients requiring medical care goal clarification, and those requiring better symptom management related to their serious illness. Our goal is to prevent hospitalizations and ER visits, increase hospice referrals and length of stay, and improve patients' quality of life. Most visits are done in homes or facilities, though we also attend provider visits with patients.

Though early, initial data shows success. In the first six months of 2019, our nurse saw 82 patients in 110 visits (1.3 visits/patient). The majority of consults were to clarify medical care goals. Most common diagnoses were neurodegenerative conditions (36%) and cancer (25%). The majority of patients had documented discussions about advance care planning (87%) and review of advance directives (73%). After palliative care consultation, 38% of patients seen were referred to hospice, with average LOS 36.6 days.

Moving forward, we are partnering with regional SNFs and hope to start a pilot program to consult on their high-risk patients. We anticipate this year of grant funding will enable us to show value and convince other payors to cover our expenses, allowing us to serve more patients and help them get the best care possible with earlier access to palliative care.

Author

Jennifer A. Blechman, MD, HMDC
Palliative Care Medical Director
Partners In Care
2075 NE Wyatt Ct
Bend, OR 97703
(541) 382-5882

Get the latest updates in your inbox!