A Decade Of Data: Findings And Insights From The National .

2y ago
15 Views
2 Downloads
1.89 MB
53 Pages
Last View : 2m ago
Last Download : 2m ago
Upload by : Genevieve Webb
Transcription

A Decade of Data:Findings and Insights fromthe National Palliative Care Registry Maggie Rogers, MPHSenior Research Manager, CAPCRachael Heitner, MA, CHPCAResearch Associate, CAPCJuly 19, 2018 at 1:00 p.m. ET

Practical Tools for Making Change November 8-10 Orlando, FLPre-Conference Workshops November 7 Boot Camp: Designing Palliative Care Programs in Community SettingsNEW! Payment Accelerator: Financial Sustainability for Community Palliative CareSeminar Keynote LineupDiane E. Meier, MD,FACPDirector, Center toAdvance Palliative CareEdo Banach, JDPresident and CEO,National Hospice andPalliative CareOrganizationElisabethRosenthal, MDAuthor, An AmericanSickness andEditor-In-Chief,Kaiser Health NewsJay D. Bhatt, DOPresident, HRET andSenior VP and CMO,American HospitalAssociationLEARN MORE AND REGISTER capc.org/seminarChristy Dempsey,MSN, MBA, CNOR,CENP, FAANAuthor, The Antidote toSuffering and CNO,Press Ganey AssociatesEdwardMachtinger, MDDirector, Women’s HIVProgram, University ofCalifornia, SanFrancisco

A Decade of Data:Findings and Insights fromthe National Palliative Care Registry Maggie Rogers, MPHSenior Research Manager, CAPCRachael Heitner, MA, CHPCAResearch Associate, CAPCJuly 19, 2018 at 1:00 p.m. ET

Polling QuestionReasons for joining today’s webinar (check allthat apply)A. More information about the RegistryB. National growth and trendsC. Palliative care encounters and reach into thehospitalD. Staffing and workloadE. Latest findings on program models and featuresF. Case studies on successful programs

About the Registry& Analyses

National Palliative Care Registry History Established a decade ago as a jointproject between the Center to AdvancePalliative Care and the National PalliativeCare Research Center

National Palliative Care Registry Purpose Provide actionable data that programs canuse to secure, expand and retainresources for delivery of high-qualitypalliative care Promote standardization of structure andprocess in palliative care programs Support the establishment of newpalliative care programs where none exist

19001850The estimated number of hospitals withpalliative care has drastically increased in thepast 0.02008200920102011201220132014Count of Hospitals with a Palliative Care ProgramPercent of Hospitals with a Palliative Care Program20152016

What is the Registry? Annual survey on palliative care program’soperations, service delivery, and processes– Programs enter data once per year– No patient-level data– No patient reported outcomes (PROs)– Questions aligned with nationalrecommendations from the NCP Free and open to all programs– Hospital, home, office/clinic, nursing homeregistry.capc.org

Polling QuestionDo you currently participate in the NationalPalliative Care Registry?A.B.C.D.Yes, I submitted data this yearNo, but I have participated in the pastNo, I have never participatedN/A I am not part of a palliative care program

Approximately 20% of hospitals with palliativecare programs participate each yearCircle size represents the size of the hospital (total beds) a number of palliative care programs in settings outside of the hospital

Answers questions for programs, such as:How has myreach intothe hospitalchangedover time?How does mystaffingcompare toprograms ofa similarsize?Has myprogramgrown at thesame rate asmy peerprograms?Answers questions for the field, such as:How manyprogramsmeet nationalstandards onstructure andprocess?What areprogrammaticgaps forpalliative careprograms inhospitals?Arepalliative careprogramsreaching allpatients inneed?

Over TimeReports Help palliative careprograms measure theirprogress and track theiroperational capacity andreach over time Used to set internalprogram goals andtargets based onhistorical performance Key metrics such aspenetration (initialconsults/annualadmissions), staffing,hospital discharges

PeerComparisons Help palliative careprograms evaluateagainst similar peerprograms Reports includeaverages, medians,and percentiles forcomparison groups

Impact for Programs Make the case for more resources (i.e. staff),show that your program is understaffed Demonstrate value to the hospital’s C-Suite,Board of Directors, system leaders, and otherleadership meetings Set program targets or internal benchmarksfor the year and years to come Lead discussions in palliative care teammeetings on process and effectiveness Plan for expansion into the community

Number of years of participatingover the past decade10 years9 years8 years7 years3237426 years775 years784 years3 years2 years1 yearThankyou!!46105141175330

Over the past decade, we’velearned that palliative careprograms Need actionable data to advocate for moreresources & seek out peer comparisons tosee where their program stands Are often understaffed and overworked Are not always able to reach nationalrecommendations Spreading beyond the hospital intocommunity settings

About the Analysis 1,063 unique hospital palliative careprograms over time– Of which, 79 are pediatric programs 396 unique hospital palliative careprograms in the 2017 analysis– Of which, 31 are pediatric programs Findings are presented separately forpediatric palliative care programs

Patient Encounters& Hospital Reach

Palliative Care Service PenetrationPalliative care service penetration is the percentage ofannual hospital admissions seen by the palliative careteam. Penetration is used to determine how wellpalliative care programs are reaching patients in need.100 initial consults / 3,500 hospital admissions 2.9% penetration

Penetration has more thandoubled since .00.020082009201020112012Mean Penetration20132014Median Penetration201520162017

Palliative Care Programs, 20175.3%Penetration830Initial Consults3.2Visits per Patient Variesdepending onthe type ofhospital,including size Depends on themake-up of thepatientpopulation Larger hospitalsprovide a largernumber of initialconsults 1,302 for largehospitals with300 bedscompared to376 for smallhospitals with 150 beds 1 initial consult 2.2 follow-upvisits perpatient during asingle hospitalstay

Pediatric Programs, 20173.1%Penetration326.5Initial Consults4.4Visits per Patient Based onpediatricadmissions Smallerhospitals reacha largerpercentage ofannual hospitaladmissions Range:70 – 1,309 Larger hospitalsprovide a largernumber of initialconsults 1 initial consult 3.4 follow-upvisits during thehospitaladmission More visits perpatient thanadult programs

Smaller hospitals reach a larger% of annual hospital admissions6.75.65.55.04.64.3 150 beds150-299 bedsMean Penetration (2017)Median Penetration (2017)300 beds

Penetration Differences, 2017 Teaching Status: Teaching hospitals see anaverage of 4.9% compared to 5.9% for nonteaching hospitals (trend holds across allhospital sizes) Pal Care Trigger: Hospitals with automaticscreening criteria see an average of 6.0% ofadmissions compared to 5.0% for hospitalswithout a trigger Follow-ups: Programs providing at least 1follow-up visit per patient see a smallerpenetration (4.9%) compared to programsthat provide an initial consult without followup visits (5.6%)

Palliative CareProgram Staffing

Percent of Programs Reporting the followingStaff Disciplines, 2017Physician83.6APRN80.1Social Worker67.7Chaplain55.6RN48.1Support Staff35.2Administrator29.4Medical Director27.4Pharmacist9.5Fellow8.4PA6.1Hospice Liaison4.9Nutritionist4.3Music/Art Therapist4.3Ethicist4.0Childlife Specialist4.0PT or OT3.2Massage .9Core Interdisciplinary Team

Growth in Staffing Full-time Equivalent forthe Interdisciplinary Team(Physicians, APRNs, RNs, Social Workers, Chaplains)5.63.23.12.32.020081.9200920102011 150 beds20122013150-299 beds2014300 beds201520162017

Growth in Staffing FTEs limited tolarge hospitals and .7 150 beds1.60.92008150-299 bedsPhysician1.8APRNRNSocial Worker2017300 bedsChaplain

Pediatric Programs: Percent of ProgramsReporting the following Staff DisciplinesPhysician100.0APRN77.8Social Worker63.0Chaplain59.3RN44.4Support Staff55.6Administrator29.6Medical Director37.0Fellow48.1Music/Art TherapistEthicist18.53.7Childlife SpecialistPT or OTMassage e Interdisciplinary Team

Pediatric Programs: Staffing FTEs0.30.20.60.6Not enough data tocompare back to 2008.0.70.81.51.520152017PhysicianSmall increases since2015 across alldisciplines, with thelargest growth also beingin APRNs on teams.1.00.8APRNRNSocial WorkerChaplain

Hospital Program Models:– 81% of programs are internal to the hospital,where all team members are employed by thehospital– 3% are administered by an outside entity likea hospice– 16% are partially internal with additionalcontracted services Staffing Models:– 90% of Physicians, APRNs, RNs, and SWsare funded through the palliative care budget– Nearly 30% of chaplains are either in-kind(paid out of other budgets) or are volunteer

More adequately staffed programssee a larger percentage of annualhospital admissions6.75.44.63.4 1.5 FTE per 10,0001.5-2.0 FTE per 10,000Mean Penetration2.1-3.0 FTE per 10,0003.0 FTE per 10,000Median PenetrationBased on: Interdisciplinary Palliative Care Team FTE per 10,000 Hospital Admissions

Programs with higher penetrationhave higher billable workloadNumber of Initial Consults per 1 FTE Billable Providerby Penetration706517411297Penetration: 3%Penetration: 3-4%Penetration: 4-6%Workload Number of initial consults per 1 FTE of Physician or APRN or PAPenetration: 6%

Palliative CareProgram Features

Top 4 Referrals (2017)Referring SitesOncology Unit8%Step-down Unit13%Intensive Care Unit24%Medical/Surgical Unit45%0%Referring ritical Care14%Internal/Family Medicine22%Hospital Medicine53%0%20%40%Mean % of Patients Referred from 60%

Pediatric: Top 4 Referrals (2017)Referring SitesPediatrics8%Medical/Surgical Unit12%Oncology Unit15%Intensive Care Unit40%0%Referring pitalist12%Oncology20%Pulmonary/Critical Care26%0%20%Mean % of Patients Referred from

Top 5 Primary Diagnoses calInfectious

Pediatric: Top 5 Primary genitalCardiacPulmonary

Programs meeting NCP GuidelinesProgram FeatureAdultProgramsPediatricPrograms24/7 Availability38.7%81.5%Team Wellness Plan46.7%61.5%Bereavement Plan48.7%79.2%Quality Improvement (QI) Plan71.4%54.2%Education Plan74.0%87.5%Physician on Team83.6%100.0%Social Worker on Team67.7%63.0%Chaplain on Team55.6%59.3%At least one HPM Certified Clinician83.6%83.9%Established Relationship with a Hospice97.5%96.6%

What’s New? 2 new reports on billable workload on thedashboard now for hospital programs Fall 2018: Gap report on where programs arenot meeting national recommendations andthe resources that can help get them there January 1st 2019– New and improved version of the hospital surveywith pediatric module– New and improved version of the home and longterm care surveys– Reports for home and long-term care programs

Making the Case forMore ResourcesCase Study43

St. Mary Medical Center Used Registry reports toshow:– Palliative care program’spenetration was in the top75th percentile for peer groupand reaching patients in needappropriately– Team members areoverworked compared to peergroup average, top 75% forworkload– Palliative care team isunderstaffed, staffing FTE fellbelow the 25th percentile forpeer group44Workloadabove the75thpercentilefor thepeer group

St. Mary Medical Center Action: Leadership meeting with hospital staffingcommittee to request additional staffing resources Outcome: More staff!– 1.0 FTE palliative care nurse practitioner (APRN)– 0.2 FTE palliative care registered nurse (RN)– Palliative care recognized as its own service line in thehospital Read more: rive-palliative-care-program-growth/45

MappingCommunityPalliativeCare46

Three-year project to map all palliativecare programs serving community servicesites nationwide– Funded by the Gordon and Betty MooreFoundation– To make it easier for patients and theirfamilies to find local resources– To measure palliative care access and informthe fieldmapping.capc.org47

Preliminary Results: County Coverage

Preliminary Results: Office/Clinics and Long-term CareFacilities

GetPalliativeCare.orgAHA AnnualSurvey ghlighted in the directory

GetPalliativeCare.orgAHA AnnualSurvey ghlighted in the directory

National Palliative Care Registry pc.orgPhone:212-201-2689 The Registry is FREE and opento all palliative care programs. CAPC Membership is NOTrequired to participate.

Questions?Please type your question into the questionspane on your WebEx control panel.

37 32 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years Thank you!! Over the past decade, we’ve . 2017 5.3% Penetration Varies depending on the type of hospital, including size Depends on t

Related Documents:

a more granular perspective. From 1930-2021, dividend income's contribution to the total return of the S&P 500 Index averaged 40%. Looking at S&P 500 Index performance on a decade-by-decade basis shows how dividends' contribution varied greatly from decade to decade. FIGURE 2 Dividends' Contribution to Total Return Varies By Decade

2.2% per decade and 2.9% per decade for solar minimum conditions, while at solar maximum, they are 0.7% per decade and 0.8% per decade, respectively. These model results are compared to estimates of thermosphere density change derived from satellite drag observations, showing good agreement. In addition, based on a recent forecast of

Decade of War, Volume 1. Enduring Lessons from the Past Decade of Operations Joint and Coalition Operational Analysis Division, Joint Staff, Suffolk, Distribution Statement A - The Decade of War, Volume I report is approved for release and dissemination caveat.

PRISM 4, no. 2 LESSOnS LEaRnED 123 Decade of War: Enduring Lessons from a Decade of Operations1 SUMMARIzeD By eLIzABeTH yOUnG T he year 2001 began with the inauguration of a U.S. President deliberately aiming to shift the use of the military away from

3 THE FLEA THEATER A 24-Decade History of Popular Music: 1776-1836: Work in Progress 3 A 24-DECADE HISTORY OF POPULAR MUSIC I suppose I’ve been subconsciously kicking around the idea for A 24-Decade History of Popular Music for many years. I can pinpoint the catalyst to an AIDS action I attended in 1987.

The number of poles determines the roll-off rate of the filter. A Butterworth response produces -20 dB/decade/pole Æa first-order (one-pole) filter has a roll-off of -20 dB/decade; a second-order (two-pole) filter has a roll-off rate of -40 dB/decade; a third-order (three-pole) filter has a roll-off -60 dB/decade and so on.

akuntansi musyarakah (sak no 106) Ayat tentang Musyarakah (Q.S. 39; 29) لًََّز ãَ åِاَ óِ îَخظَْ ó Þَْ ë Þٍجُزَِ ß ا äًَّ àَط لًَّجُرَ íَ åَ îظُِ Ûاَش

Collectively make tawbah to Allāh S so that you may acquire falāḥ [of this world and the Hereafter]. (24:31) The one who repents also becomes the beloved of Allāh S, Âَْ Èِﺑاﻮَّﺘﻟاَّﺐُّ ßُِ çﻪَّٰﻠﻟانَّاِ Verily, Allāh S loves those who are most repenting. (2:22