Oct 272011

 by Larry Beresford

The Hospital Association of Southern California, which convened a Palliative Care Committee to provide mutual support among its members working on palliative care initiatives, recently changed the committee’s name to the Care Transitions Committee, reflecting the affinities between these two major quality currents within America’s hospitals. But as the cover story in the most recent Quarterly newsletter of the American Association of Hospice and Palliative Medicine asks: “Where is Palliative Care in the Readmissions Boom?”

A growing body of research has documented palliative care’s ability to help seriously ill, hospitalized patients clarify their goals for treatment, manage their symptoms, and plan for the next stages of their care in alignment with their values, often at lower cost of hospital resources and higher patient satisfaction. Palliative care teams in the hospital often see the patients with the most serious illnesses, psycho-social complications and multiple chronic conditions, who are also at higher risk for readmission. Palliative care, in contrast to hospice, does not require a terminal diagnosis or time-limited prognosis. It can be offered from the point of diagnosis of a serious, chronic or incurable condition, in conjunction with any other treatment modality. Palliative care focuses on quality of life, relief of pain and suffering, and support for emotional and family concerns.

But palliative care is also serious and complex specialty care, with board certification offered in Hospice and Palliative Medicine, accredited medical fellowship opportunities, and advanced certification for hospital palliative care programs offered since September by the Joint Commission. A growing body of quality measures used in palliative care has been recognized by the National Quality Forum. Although it has been slower to develop outside the hospital’s four walls, the number of hospital-based palliative care services has steadily grown to 1,568, 63 percent of all hospitals with 50 or more beds. The same way that hospitals and hospital medicine groups are coming to recognize their responsibility for the outcomes of their discharge plans after the patient leaves the hospital, palliative care teams are now exploring their role post-discharge.

So why isn’t palliative care, with its specialty recognition and demonstrated positive outcomes, more front-and-center in current national efforts to improve care transitions across the health care system, thereby contributing to preventing unnecessary rehospitalizations? Some places, like the Hospital Association of Southern California, have acknowledged the connection. Others have given palliative care representatives a seat at the table when cross-setting teams meet to work on improving care transitions in their communities.

But Dr. Diane Meier, director of the Center to Advance Palliative Care, tells AAHPM’s Quarterly that the biggest barrier is the absence of research demonstrating the impact of palliative care consultations in the hospital on 30-day readmission rates — in contrast to data that convincingly demonstrates palliative care’s value equation within the hospital. “I think that is an urgent, high-priority research question for our field,” Dr. Meier says. “I am concerned that we are going to miss this window of opportunity, even though our patients are a big part of the readmission problem.” (For more information on palliative care, see the Center to Advance Palliative Care.)

 Key words: palliative care, care transitions, discharge planning, readmissions

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