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Transcript of Metrics That Matter - colemanpalliative.uchicago.edu · intensive care unit 4.8 times more likely...
Metrics That Matter
1
26 February 2016
Session Objectives
At the end of this session, you will be able to
1. Identify core metrics to benchmark the performance of a palliative medicine program
2. Enter data in formats that facilitate rapid analysis
3. Identify organizational support staff who can provide access to relevant data
The National Environment for Palliative Care Teams
• 4.4% of patients admitted to an acute care hospital in the US had a palliative medicine consultation in 2014 (range 0.3%-16.8%)
• In 2012, 3.6% of patients had palliative medicine consultations
• Source National Palliative Care Registry sample of ~10% of US hospitals
Palliative Care Registry and Outcomes Evaluation
Aim: To provide metrics on palliative care program characteristics and outcomes across fellowship sites to improve patient care and costs
1. Palliative Care Registry – Study of characteristics of palliative care programs at all participating
sites
– Administered in 2015 for program information, 2012 – 2014
2. Outcomes Study – COMPData: Hospital inpatient billing information for patients
discharged to hospice or died in-hospital
Types of Services offered by Palliative Care Services for Responding Institutions to the Registry (N=23)
• 74% have an inpatient consultation service
• 52% have outpatient clinics
• 43% have home palliative care programs
• 22% have services in skilled nursing facilities
• 9% have an inpatient palliative care unit
• 9% have inpatient hospice units
Staffing Models: 2012 and 2014, N = 12
Provider 2012 FTEs
Median (25 – 75%) 2014 FTEs
Median (25 – 75 %)
Physician 0.9 (0 – 2.3) 1.1 (0.2 – 2.7)
Advanced nurse practitioner
1.0 (0.8 – 1.0) 1.0 (0.8 – 2.0)
Social worker 0.3 (0 – 0.5) 0.4 (0.1 – 1.0)
Chaplain 0 (0 – 0.5) 0 (0 – 0.5)
Other 0.2 (0 – 1.0) 0.2 (0 – 1.3)
Proportion of Hospitals with Each Provider Type in the Palliative Care Program (N = 11)
83% 83%
75%
42%
92%
75%
Physician Advanced nursepractitioner
Social worker Chaplain At least 2 typesof providers
At least 3 typesof providers
--Interprofessional Teams--
Discharges to Hospice by Team Composition % of hospital discharges to hospice versus in-hospital death
2011 2012 2013 2014With SW and APN both on team (n = 16,349)
Without SW or APN on team (n = 10,830)
0%
10%
20%
30%
40%
50%
2011 2012 2013 2014With social worker on team (n = 17,353)
Without social worker on team (n =8,460)
Palliative Care Consults as a Percent of Total Discharges
Beauchamp TL. Principles of Biomedical Ethics, 5th ed. Oxford Univ Press 2001.
4.4%
8.0%
National Coleman Fellowship Hospitals
N = 9 hospitals reporting the number of palliative care consultations for 2014
Within the Coleman Fellowship Hospitals
Range: 1.0% - 24.4%
Patients with a palliative care consultation were…
45% less likely to have any care in the
intensive care unit
4.8 times more likely to be discharged
to hospice
For patients discharged to hospice or who died in-hospital at Rush University Medical Center
Discharge dates: Oct 2011 – Sep 2012; Oct 2013 – Sep 2014
0
1000
2000
3000
4000
5000
6000
Nu
mb
er o
f V
isit
s
New visits
Return visits
Hosp A Hosp B Hosp C Hosp D Hosp E Hosp F
Inpatient Palliative Care Service Utilization at Local Academic Medical Centers in Fiscal Year 2014
0
200
400
600
800
1000
1200
Nu
mb
er
of
Vis
its
New visits
Return visits
Hosp A Hosp B Hosp C Hosp D Hosp E Hosp F
Outpatient Palliative Care Service Utilization at Local Academic Medical Centers in Fiscal Year 2014
Funding of Palliative Medicine Teams in the Chicagoland Area (FY-14)
• The mean support from professional revenue 34.5% (range 0 to 100% of the cost of supporting a team)
• Six programs had 100% support from their hospital hospital (range 0 to 100%), and mean support is 63.9%
• The support from hospice range is 0-50%, and mean support is 12%
• Philanthropy supported an average of 16.5% of operational support (range 0% to 100%)
Metrics That Matter: Some Key Metrics
14
• Number of inpatient consultations
• Number of outpatient consultations
• Full-time equivalent staff by role
• Discharges to hospice versus in-hospital death
– Length of hospital stay
– Intensive care unit use
– Reason for admission
And From These Metrics…
15
• Ratio of inpatient consultations to outpatient consultations
• Inpatient consultations per palliative care team FTE
• Outpatient consultations per palliative care team FTE
• Length of hospital stay for patients discharged to hospice versus in-hospital death
• Number of ICU days for patients discharged to hospice versus in-hospital death
Palliative Care Consults and End of Life Outcomes, 2013 - 2014, Rush University Medical Center
97
332
280
160
Hospice In-Hospital Death Hospice In-Hospital Death
Without Palliative Care Consult With Palliative Care Consult
23% discharged to hospice
64% discharged to hospice
Tips on Collecting Data
17
• Think about how the data should be organized and what you want to accomplish
• Use a spreadsheet
• Create a data dictionary
• Use consistent coding
• Pilot data collection with a few records
• Review pilot data and plan for how you will use it
Example
18
Patient Identifier Consultation Date Reason for Consultation Provider
ABCD Jan 1, 2016 Don't know T. Johnson
EFGH 1/2/2016 cancer SPM
IJKL Jan-05-16 cancer, lung Johnson, T.
Example
19
Patient Identifier Consultation Date Reason for Consultation Provider
ABCD 01/01/2016 99 021
EFGH 01/02/2016 1 022
IJKL 01/05/2016 1 021
Provider Look-up Table
021 Johnson, Tricia
022 Miller, John
023 Jones, Mary
Reason Look-up Table
1 Cancer
2 Stroke
3
…
99 Unknown
Key Organization Support Areas
20
• Quality: Performance metrics, outcomes, benchmarking data
• Finance: Cost per admission, billing information
• Information services: Electronic medical record information; billing information