A Quality Improvement Approach to System-Wide Physician Referral Patterns for Hospice Care (QI803)

Abstract

•Recognize that referral for hospice care is a behavior amenable to behavioral feedback.•Physicians change their behavior when given their personal performance for hospice referral. Hospital-based hospice programs generally have short lengths of service in home hospice care—much shorter than free-standing hospice programs Improve Hospice Length of Service by giving physicians feedback on their performance. The OhioHealth Clinical Guidance Council, comprised of physician subcommittees by specialty, sets standards of care for purposes of improving quality and decreasing cost by facilitating decrease in variation for 3500 physicians serving the system across 40 counties in central Ohio. The, median length of stay of patients referred by all OhioHealth physicians was obtained for 2015. For the oncology, cardiovascular, neurosciences, primary care and hospitalist clinical guidance councils, a letter from the Chair was sent to each physician noting gap between the council's opinion about optimal length of stay, the length of stay reported by the National Hospice and Palliative Care Organization (NHPCO), and the median length of stay of all patients referred by OhioHealth physician members of that clinical guidance council. A chart graphing the median length of stay by member, indicating the name of the member to which the letter was directed, was mailed to each physician. One year later, for calendar year 2016, the measurement of median length of stay by physician was repeated. For all physicians in 2015, the median length of stay in targeted specialties was 15 days, in those not targeted (control), 16 days. In 2016, the median length of stay for all physicians in targeted specialties was 25 days. In those not targeted (control) it was 10 days. The national median length of stay in hospice care is 17 days. The median length of stay for all OhioHealth Hospice patients was 10 days at the time this project was conducted. A simple QI approach yielded a 250% improvement in hospice median length of stay between intervention and control to a level above the national median.