Evaluating Prognostication Tools to Aid in Hospice Referral, Certification & Recertification Narratives of Patients Afflicted With Pulmonary Arterial Hypertension (SA545-D)

Abstract

•Understand the utility of the REVEAL PAH risk calculator vs LCDs in prognostication of PAH.•Understand how prognostication tools can enhance hospice certification and recertification narratives. Pulmonary Arterial Hypertension is a progressive and fatal disease with no cure. A recent small study suggests that a majority of patients with PAH die in the hospital (67%) and most in the ICU (83%). Research suggests that patients benefit most from receiving hospice care from 2-3 months. Local Coverage Determinations (LCDs) were created to assess whether patients are likely to be in their last 6 months of life. However, these LCDs have not been updated with recent disease-specific prognostication research. We asked whether there were newer disease-specific prognostication tools that could be compared to or used with the LCDs to better predict PAH survival time. To review the literature for PAH prognostication tools, then evaluate and compare prognostication tools for PAH as relevant to hospice referral, certification, and recertification narratives. Phase 1: A review of the PAH-specific prognostication literature to identify target tools. Phase 2: A retrospective analysis of 100% sample of hospice patients with a diagnosis of PAH who received hospice services at one large nonprofit hospice and palliative care provider in the Mid-Atlantic region since 2010. Phase 1: 12 articles on prognostication of PAH were identified, of which one tool, the REVEAL, was the most highly regarded. Phase 2: A 100% sample (n=21) of charts from deceased hospice patients seen between 2010-2013 were selected for a retrospective analysis. The analysis will compare the LCDs against the REVEAL prognostication tool in predicting actual date of death and length of stay in hospice. The REVEAL risk calculator is a prognostication tool that could aid hospice and palliative care physicians in more accurately predicting survival time as well as appropriate and timely referrals to hospice.