Disrupting the palliative care status quo: clinical technology for improved palliative care

Palliative medicine is one of the fastest-growing medical specialties in the United States, evident in the fact that nearly 90 percent of large U.S. hospitals (consisting of 300 beds or more) now have a palliative care program.

Palliative care aims to improve the quality of life for patients living with serious illness, a population of approximately 90 million in the U.S., and offers a number of benefits to patients, families and care providers.

However, despite the increased number of palliative care teams in the U.S., access to this level of care in many hospitals continues to be inadequate. The specialty has grown in recent years, but there is still a long road ahead for raising awareness around the benefits of palliative care and providing the appropriate training to bring this level of care to those who need it, in the most effective way possible. Some of the largest challenges to improving palliative care include identifying patients in need of this type of care, and providing timely, effective care that reduces suffering, helps address overall length of stay and readmissions, and provides cost savings.

Technology offers tremendous possibilities for addressing these challenges and can be used to help improve the delivery of palliative care in three key ways:

1. Identifying the right patients
One of the biggest challenges related to palliative care lies in the process that physicians use to identify patients in need. Not only is palliative care often misconstrued as hospice care, which is reserved for terminally ill patients that have run the course of treatment options, but identifying the right candidate can also be difficult using traditional screening tools and triggers.

The screening tools typically used for identifying patients with palliative needs are often manual, require review of the medical record, and are often cumbersome. Meanwhile, traditional triggers include a number of concurrent factors, such as number of hospitalizations, stage of illness and symptom burden, which are difficult to combine in a meaningful way to paint an accurate picture of the patient’s health. Traditional screening tools and triggers make identifying palliative care patients difficult, leading to consults that are often given too late in the process to provide benefit.

Clinical monitoring tools that leverage real-time and predictive analytics, however, can provide a more accurate depiction of a patient’s current health. Having a clear picture of a patient’s current and projected state of health not only helps physicians better identify those in need of palliative care, but it also gives patients and families objective data to help them make appropriate decision around end-of-life care.

2. Reducing length of stay
In addition to helping identity patients that can benefit from the expertise of palliative care teams, clinical technology can also help appropriate patients receive more effective end-of-life care, allowing for discharge earlier, reducing their overall length of stay. Helping ensure that a patient’s pain is always managed, and maximizing quality of life while also decreasing his or her length of stay also helps increase patient and family satisfaction.

In fact, a pilot study by Yale New Haven Hospital incorporating PeraHealth’s Rothman Index (RI) into a trigger for palliative care found that patients receiving palliative intervention had a decrease in the mean length of stay from 26.3 days for all other groups, to 13.9 days. Additionally, the 30-day readmission rate was reduced from 25 perecnt in the non-palliative care group to 4% in the intervention group. Overall, the study demonstrated the benefits of using clinical surveillance tools and triggers for palliative care, as they helped improve the prevention of 30-day readmissions and reduce length of stay for Yale New Haven Hospital’s palliative care patients.

3. Cutting costs of care
As the baby boomer generation ages and contributes to a growing, aging population, there is a need to improve quality of care and help reduce costs. Today, end-of-life care remains expensive and puts a strain on the healthcare system. The Center to Advance Palliative Care finds that today, roughly 68 percent of Medicare costs are tied to patients with four or more chronic conditions – in other words, a typical palliative care patient. Moreover, they predict that U.S. hospitals could save up to $6 billion per year if palliative care were fully utilized in hospitals.

A widely cited study on cost savings associated with U.S. hospital palliative care found that patients across eight U.S. hospitals who received palliative care had lower hospital costs – in fact, the study found that an average 400-bed hospital with palliative care consultation could realize net savings of $1.3 million per year.

Additionally, the Yale New Haven Hospital study found that costs were lowered by 54 percent for patients receiving palliative intervention. These findings demonstrate that the use of clinical technology in palliative care, such as the RI, may have the potential to help bend the cost cure for the healthcare system.

There is widespread agreement that palliative intervention can help improve end-of-life care for patients and their families. However, there is still a need to improve the awareness around palliative care and improve access to expert palliative care teams that. Technology can help overcome existing obstacles to improving palliative care: better identifying appropriate patients, reducing their length of stay, and thus lowering costs of care. Yale New Haven understands the challenges associated with a complex palliative care process, which is why they launched their pilot study to explore how technology could assist their teams and improve patient care.

By Michael Rothman, PhD, co-founder and chief science officer, PeraHealth

With the availability of a simple method to identify appropriate patients for palliative care, more patients may have greater access to the palliative care they need. Meanwhile, predictive analytics technology and clinical monitoring tools will also serve as a way to provide clinicians with the information they need to proactively improve care, benefitting not only patients and their families, but also hospitals and the healthcare industry at large.

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