Enhancing Provider Knowledge and Patient Screening for Palliative Care Needs in Chronic Multimorbid Patients Receiving Home-Based Primary Care

Abstract

This article describes a pilot model to increase palliative care (PC) knowledge and collaboration among providers and to systematically identify chronic multimorbid home care patients who would benefit from focused discussion of potential PC needs. Thirty health care providers from a home-based primary care team attended interdisciplinary trainings. The Palliative Performance Scale (PPS) tool was used to trigger discussions of potential palliative needs at team rounds for patients who scored below a cutoff point on the tool. Palliative Performance Scale implementation added little burden on nurses and triggered a discussion in 51 flagged patients. The tool successfully identified 75% of patients who died or were discharged. Screening was systematic and consistent and resulted in targeted discussions about PC needs without generating additional burden on our PC consult service. This model shows promise for enhancing collaborative patient care and access to PC.

Keywords

multimorbidity chronic care home care palliative care screening interdisciplinary care

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References

Anderson

Downing

Hill

. Palliative performance scale (PPS): a new tool. J Palliat Care. 1996;12(1):5–11.

Chan

. Revisiting the palliative performance scale: change in scores during disease trajectory predicts survival. Palliat Med. 2012;27(4):367–374.

Weissman

Meier

Spragens

. Center to advance palliative care palliative care consultation service metrics: consensus recommendations. J Palliat Med. 2008;11(10):1294–1298.

Weissman

Meier

. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the center to advance palliative care. J Palliat Med. 2011;14(1):17–23.

Matzo

. Palliative care: prognostication and the chronically ill. Am J Nurs. 2004;104(9):40–49.

Temel

Greer

Muzikansky

. Early palliative care for patients with metastatic non–small-cell lung cancer. N Engl J Med. 2010;363(8):733–742.

Morrison

Penrod

Cassel

. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783–1790.

Morrison

Dietrich

Ladwig

. Palliative care consultation teams cut hospital costs for medicaid beneficiaries. Health Aff (Millwood). 2011;30(3):454–463.

Harrold

Rickerson

Carroll

. Is the palliative performance scale a useful predictor of mortality in a heterogeneous hospice population? J Palliat Med. 2005;8(3):503–509.

10.

Zare

Jackson

. Who needs palliative care? using the palliative performance scale to screen for palliative consultations. J Pain Symptom Manage. 2011;41(1):316–317.

11.

Michael

. Home-Based Primary Care Program: VHA Handbook 1141.01. Washington DC: Department of Veterans Affairs, Veterans Health Administration; 2007.

12.

American Association of Colleges of Nursing. End-of-Life Nursing Education Consortium (ELNEC). Washington, DC: American Association of Colleges of Nursing; 2004.

13.

Wharton

Nnodim

Hogikyan

. Assessing health status differences between veterans affairs home-based primary care and state medicaid waiver program clients. J Am Med Dir Assoc. 2013;14(4):260–264.

14.

Gill

Gahbauer

Han

Allore

. Trajectories of disability in the last year of life. N Engl J Med. 2010;362(13):1173–1180.