A Statewide Intervention to Improve Access to Hospice and Palliative Care for Seriously Ill Medicaid Enrollees (416-A)

Abstract

1.Discuss training and quality improvement components of a statewide intervention to improve access to hospice, palliative, and supportive care for seriously ill Medicaid enrollees.2.Discuss a model program that may guide future community-based interventions to facilitate collaboration between primary care providers and palliative care experts. Hospice, palliative care, and other support services improve pain, symptom management, and quality of life for seriously ill patients but remain underutilized by the low income population enrolled in Medicaid. We evaluated a systems intervention in a statewide network of primary care practices to improve access to hospice, palliative care, and other supportive resources for Medicaid recipients. Experts in palliative care, primary care, and quality improvement designed and delivered a prospective educational and quality improvement intervention, administered to 495 care managers serving seriously ill aged, blind, and disabled (ABD) Medicaid enrollees. Quality improvement components included feedback of practice quality measures, engagement with local hospice and palliative care, and a toolkit for practice change. Outcome measures included surveys to evaluate the educational components and change in care manager practices using two key quality measures: (a) percentage of at-risk ABD patients asked at least one palliative care question and (b) percentage of at-risk ABD Medicaid enrollees referred to receive palliative care services and hospice. Of 495 care managers, 471 responded to the survey (95.2%). Expected practice changes included more active role in advance care planning (28.6%); supporting patients and families (21.4%); identifying patients for discussion of hospice/palliative care (18.0%); using practice toolkit (10.4%); engaging medical providers (9.9%); hospice/palliative care referrals (7.4%). From June 2010 to June 2011, the percent of at-risk Medicaid enrollees asked palliative care questions increased (7.7% vs. 29.2%), as did the cumulative number of palliative care and hospice referrals (3 vs. 134). A statewide intervention targeting care managers in a primary care practice network is effective to improve access to hospice, palliative care, and other supportive resources for seriously ill, Medicaid recipients.