An Accountable Care Organization (ACO) and an Academic Medical Center's Palliative Care Team Address Workforce Needs by Integrating Care Coordinators to Assist with Hospice Referrals in an Acute Care Setting (S733)

Abstract

•Identify a common challenge of increasing volume of inpatient palliative care consultation in the setting of limited palliative care specialist workforce.•Demonstrate collaborative workforce solutions between an academic medical center and its Accountable Care Organization.•Report outcomes showing high rates of consult completion by care coordinators, high rates of hospice referrals, and low 30-day readmission rates for patients enrolled in hospice through this relationship. A well-established palliative care program at an academic medical center experienced a 34% increase in palliative care consults within 1 year without a concomitant increase in workforce (Y2011 = 1496 consults versus Y2012 = 2014 consults). The ACO's Palliative Care working group developed a pilot program that integrated care coordinators (Registered Nurses with hospice experience) into the palliative care team to assist with hospice eligibility consults. Objective 1: Shift 25% of consults requesting hospice eligibility from the palliative care team to an ACO RN care coordinator. Objective 2: Refer 50% of hospice eligible patients to hospice when the patient is hospice eligible. Objective 3: Observe 30-day re-admission rates below the national standards for medical (16.1%) and surgical (12.7%) acute care discharges for the patients enrolled in hospice upon discharge. Care coordinators were integrated into the palliative care consult workflow. The care coordinators acted as the first clinician to evaluate patients when a hospice eligibility consult was requested. Prospective data was collected and descriptive statistics were used to describe outcomes. Objective 1: 100% of consults for hospice eligibility were seen by care coordinators. Objective 2: 87% of hospice eligible cases were referred to hospice. Objective 3: A 30-day re-admission rate of 8.8% was observed. Nationally there is a known shortage of palliative care specialist providers. This pilot program revealed that integrating care coordinators within the palliative care team with the support of an ACO can enhance referral, access, and the anticipated benefits of hospice for patients identified as hospice eligible in an acute care setting.