A Pilot Study of Palliative Medicine Fellows Hospice Physician Home Visits (773)

Abstract

1.Upon completion of this presentation, the attendee will learn the clinical features of a hospice physician home visit.2.To recognize that physician HV is an important intervention to enhance quality and continuity of care.3.To understand the issues identified during a physician HV which have not been previously reported. Home Visits (HV) may prevent unwanted hospitalizations, and increase the likelihood of dying at home. To investigate the clinical features of a hospice physician HV and explore its role in continuity of care. This was a prospective descriptive study of hospice physician HV conducted by five Palliative Medicine Fellows from an academic palliative medicine program. Data were collected on 58 consecutive HV. Patient interviews, medical charts, and physical exams were used to complete pre- and post-visit data recording forms. 58% of patients were women; median age 75 years (range 60-86). 57% had cancer. 71% had an ECOG PS of 3 or 4. Estimated prognosis was often weeks to months; 77% were DNR. 66% HV were requested by hospice case managers. 76% HV occurred in the home. The most common issues addressed during HV were: health education (88%), symptom management (79%), psychosocial/emotional support (43%) and family meetings (21%). The median visit duration was 60 minutes (range 20-120); the median travel distance and time were 25 miles (range 5–80) and 42 minutes (range 10-120). An RN/Hospice case manager was present in 95% of HV. A mean of 5.5 symptoms (± 6.3 SD) was managed per home visit. Medications were reviewed during all of the visits, except the 2. One problem was identified pre-HV, and 1.5 afterwards. Physicians who work as part of the interdisciplinary hospice team have unique responsibilities and roles and identified important issues on HV. These included education, psychosocial and emotional support, and symptom management. Most HV resulted in medication changes. Symptom control was usually for pain, although many symptoms were identified.