Latest Trends And Insights From The National Palliative .

Latest Trends and Insights fromthe National Palliative Care Registry Maggie Rogers, MPHDirector of Research, CAPCRachael Heitner, MA, CHPCAResearch Manager, CAPC

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Latest Trends and Insights fromthe National Palliative Care Registry Maggie Rogers, MPHDirector of Research, CAPCRachael Heitner, MAResearch Manager, CAPC

Poll QuestionHave you (or your organization) ever submitteddata to the National Palliative Care Registry ? Yes No

The National Palliative Care Registry Annual survey onpalliative care program’soperations, servicedelivery, and processes Programs participate oncea year No patient-level data orpatient-reported outcomes Purpose: Provide actionable datathat programs can use tosecure and retainresources Promote standardizationof structure and process Support the establishmentof new palliative careprogramsFree and open to all hospital and community programs

2018 Updates Focused Scope Survey Reorganization Length and Question Changes One of Many Data Resources

Who Were Our 2018 InpatientParticipants?

2018 Hospital SurveyAdult Programs: 425 ParticipantsOffice Practice orHome Health AgencyHospice 150 Beds7%7%21%AdminHome50% 300 BedsBedSize29%86%Hospital92% areNot-for-ProfitHospitals150-300 Beds51% hingHospitals

2018 Hospital SurveyPediatric Programs: 54 Participants 150 BedsHospital17%44%AdminHome 300 BedsBedSize39%100%150-300 Beds85% areNot-for-ProfitHospitals100% hingHospitals

Patient Encounters

Palliative Care Service PenetrationPalliative care service penetration is the percentage of annual hospitaladmissions seen by the palliative care team. Penetration is used todetermine how well palliative care programs are reaching patients in need.100 initial consults / 3,500 hospital admissions 2.9% penetration

Penetration has increased 124% since2008 (Adult 2008201120122013Mean Penetration20142015Median Penetration201620172018

Differences in Penetration Rates,Adults (2018) Bed Size: Hospitals with more than 300 beds see anaverage of 4.7% compared to 6.4% in hospitals withless than 300 beds Teaching Status: Teaching hospitals see an averageof 5.2% compared to 6.0% of programs in nonteaching hospitals

Differences in Penetration Rates,Adults (2018) Consult Triggers: Hospitals with automatic screeningcriteria see an average of 6.2% compared to 5.1% forhospitals without it in place Program Maturity: programs who are three years oldor less see an average of 4.4% compared to 5.7% forprograms who are four years old or older

Patient Encounters, Adults (2018)Initial Consults892Follow-Up Visits1,761Visits per Patient2.8 Larger hospitalsprovide a largernumber of initialconsults 1,223 for largehospitals with 300 beds compared to 358for small hospitalswith 150 beds Larger hospitalsprovide a largernumber of follow-upvisits 2,499 for largehospitals with 300 beds compared to 474for small hospitalswith 150 beds 1 initial consult 1.8follow-up visits perpatient during a singleadmission 3.0 for large hospitalswith 300 bedscompared to 2.4 forsmall hospitals with 150 beds

Patient Encounters, Pediatrics (2018)PenetrationRate3.1% Based on thehospital’spediatricadmissionsInitial Consults293 Largerhospitalsprovide alargernumber ofinitialconsultsFollow-up Visits1,253 Largerhospitalsprovide alargernumber offollow-upvisitsVisits perPatient5.3 1 initialconsult 4.3follow-upvisits perpatient duringa singleadmission

Program Staffing

Core interdisciplinary team disciplinesare the most prevalent.Percent of Programs Reporting Specific Staff Disciplines, Adults (2018)Advanced Practice Registered NursePhysicianSocial WorkerChaplainRegistered NurseAdministrative SupportProgram Administrator (Non-Clinician)Medical DirectorFellowPharmacistPhysician AssistantHospice LiaisonMusic/Art TherapistChild Life SpecialistNutritionist/DieticianResidentMassage TherapistEthicistPhysical/Occupational TherapistPsychologistLicensed Practical/Vocational .9%2.1%1.9%1.2%1.2%0.5%41% of participatingprograms report a full,core interdisciplinary team(Physician, APRN or RN,Social Worker, andChaplain)

Pediatric programs have differentstaffing models than adult programs.Percent of Programs Reporting Specific Staff Disciplines, Pediatrics (2018)Advanced Practice Registered NursePhysicianSocial WorkerChaplainRegistered NurseAdministrative SupportProgram Administrator (Non-Clinician)Medical DirectorFellowPharmacistPhysician AssistantHospice LiaisonMusic/Art TherapistChild Life SpecialistNutritionist/DieticianResidentMassage TherapistEthicistPhysical/Occupational TherapistPsychologistLicensed Practical/Vocational 7%33.3%33.3%38.9%7.4%5.6%5.6%37% of .9%1.9%1.9%programs report a full,core interdisciplinary team(Physician, APRN or RN,Social Worker, andChaplain)

Program Staff FTEs, Adults (2018)6.0APRN FTE have seen themost growth since 2008,with a 150% increase inhospitals with 300 .60.3 150 Beds150-300 BedsPhysicianFTE: Full-Time EquivalentAPRNRNSocial Worker 300 BedsChaplain

The largest growth in staff FTEs hasbeen in large hospitals.Growth in Staffing FTE in the Interdisciplinary Team, Adults (2018)6.13.23.12.32.020082.02009201020112012 150 BedsFTE: Full-Time Equivalent20132014150-299 Beds201520162017300 BedsInterdisciplinary Team: Physician, APRN, RN, SW, Chaplain2018

Program Staff FTEs, Pediatrics (2018)4.10.20.7Chaplain0.7Social WorkerRNAPRN1.0Physician1.4FTE: Full-Time EquivalentOver time comparisonsare unavailable, asthere is not enoughhistorical data

HPM-Certified Clinicians (2018)Of the programs that reported (at least one) Hospice and PalliativeMedicine-certified staff members:Adults 83% had a certified physicianPediatrics 92% had a certified physician 61% had a certified APRN 38% had a certified APRN 25% had a certified RN 24% had a certified RN 24% had a certified socialworker 7% had a certified socialworker 8% had a certified chaplain 9% had a certified chaplain

More adequately staffed programs see alarger percentage of annual hospitaladmissions, Adults (2018)7.65.54.83.9 1.5 FTE per 10,000Admissions1.5-2.0 FTE per 10,000AdmissionsMean Penetration2.1-3.0 FTE per 10,000Admissions 3.0 FTE per 10,000AdmissionsMedian PenetrationBased on: Interdisciplinary Palliative Care Team FTE per 10,000 Hospital Admissions

Billable Provider Workload, Adults (2018)523The number of initialconsults completed bybillable providers varies bythe hospital penetration rate399349296Penetration 3.0%Penetration 3.0-4.0%Penetration 4.1-6.0%Penetration 6.0%Billable Provider Workload: Number of Initial Consults per 1 FTE of Physician, APRN, and PA

Program Features

What are the top three reasons for thepalliative care consult requests youreceive? (2018)Adults1. Establishing Goals ofCare 91%2. Pain Symptoms 55%3. End-of-Life/HospiceReferral 46%4. Advance CarePlanning 42%5. Family Support andCounseling 18%Pediatrics1. Establishing Goals ofCare 83%2. Pain Symptoms 43%3. Family Support andCounseling 43%4. Advance CarePlanning 33%5. Coordination of Care32%

Top Referral Sources, Adults (2018)Referring LocationsReferring U25.9%Pulm/Critical Care12.8%Step-Down13.1%Internal Medicine12.8%7.4%Family Medicine7.1%Oncologist6.2%OncologyEmergency Dept3.4%Less than 1% came from Geriatrics,Gastroenterology, Direct Admission,Hospice, Pediatrics, MaternalMedicine, and Neonatology (each)3% or less came from Surgeons,Cardiologists, Neurologists,Nephrologists, Gastroenterologists,Maternal Medicine, or Neonatologists

Primary Diagnoses, Adults gic7.7%Complex Chronic6.7%Infectious6.0%Dementia, Renal, Gastro,Hepatic, Trauma,Vascular, Endocrine,Hematology, Congenital,Inutero, and Prematurityeach account for lessthan 5 percent of patientdiagnoses

Palliative care programs frequentlycomplete consults early during a patient’sadmission.Consult Timing: How often are consults completed within 48 hours of admission? %Rarely12.0%Never0.2%Never0.0%

Palliative care programs strive torespond to consults requests quickly.Consult Timing: How often are consults completed within 24 hours of referral? 4%Rarely6.1%Never0.0%Never0.2%

Patient Disposition, Adults (2018)Home without Hospice23.4%Other Health Care Facility20.8%Expired17.6%Home with Hospice14.4%Hospice-Health Care Facility12.3%An additional 7% wereeither discharged to acutecare facility, left AMA, orwere not discharged fromthe hospital during thereporting period

National Guidelines &Recommendations

Does your program follow any nationalrecommendations or guidelines? (2018)AdultsPediatrics76.2%51.9%The Joint Commission AdvancedCertification for Palliative Care35.8%20.4%DNV-GL Healthcare Palliative CareProgram Certification4.5%3.7%National Consensus Project (NCP) ClinicalPractice Guidelines forQuality Palliative Care

Adherence to NCP Guidelines (2018)RecommendationAdult ProgramsPediatric Programs24/7 Availability to Patients46.1%59.3%Team Wellness Plan57.1%69.2%Quality Improvement (QI) Plan61.2%44.4%Physician on Team82.1%96.3%Social Worker on Team68.7%66.7%Chaplain on Team54.4%48.1%(At Least One) HPM-Certified Clinician83.8%84.9%

Program Funding

What are your Top Three ProgramFunding Sources? (2018)Adults1. Hospital/ParentOrganization FinancialSupport 86%2. Fee-for-ServiceClinician Billing 75%3. Philanthropy 19%Pediatrics1. Hospital/ParentOrganization FinancialSupport 85%2. Fee-for-ServiceClinician Billing 65%3. Philanthropy 63%

National Palliative Care Registry pc.orgPhone:212-201-2689 The Registry is free and open to allpalliative care programs CAPC Membership is not required toparticipate

Questions?

Palliative Care Service Penetration Palliative care service penetration is the percentage of annual hospital admissions seen by the palliative care team. Penetration is used to determine how well palliative care programs are reaching patients in need. 100 initial consults / 3,50