Assessment and Management Tools for Advancing Disease.

Abstract

As the population of the United States has aged, the number of home care patients with multiple chronic diseases has also increased. A review of the literature suggested that layering palliative care principles on traditional home healthcare could improve outcomes for patients with advancing disease. The purpose of this quality improvement project was to educate home care staff on the use of assessment and management tools to identify symptoms and provide symptom control, prevent unnecessary hospitalizations, and reduce healthcare costs in patients with advancing disease. This project took place at eight offices of a national home care agency in Kentucky and Indiana. Nurses, social workers, and therapists attended mandatory education sessions over 5 months on integrating palliative care principles into care planning for home care patients and using the Edmonton Symptom Assessment Scale (ESAS) and state-specific end-of-life planning tools. Symptoms were tracked and managed. A paired-samples t-test was used to analyze ESAS scores. Hospitalization and rehospitalization rates and costs were compared and benchmarked. Some symptoms worsened from beginning to end of the episode of care, suggesting a need for additional staff training about symptom management. The wide range of symptoms and symptom worsening suggest the need for individualized care, possibly extended home healthcare, and the inclusion of a more formal palliative care course for staff on symptom management.