Impact of a Home-Based Palliative Care Program for Advanced Heart Failure (QI816)

Abstract

•Describe an interdisciplinary home-based palliative care pilot program for patients with advanced heart failure.•Discuss preliminary outcomes of home-based palliative care intervention on acute care utilization and satisfaction. Transitions LifeCare partnered with a community hospital to offer home-based palliative care (HBPC) to patients with advanced heart failure (HF). These patients were identified by the hospital as high utilizers of services. HBPC provided symptom management, psychosocial support, advance care planning, and patient education. Evaluate the impact of HBPC support on hospital utilization and quality of care. This is a case series of 20 patients with advanced HF who were high utilizers of healthcare resources. Initial HBPC consultation occurred within 7 days of hospital discharge and care continued for 4-6 weeks. A nurse-directed interdisciplinary team provided physical assessment, symptom management, medication reconciliation, advance care planning, and psychosocial support. The Quality Data Collection Tool for Palliative Care was used to collect symptom management data and the FAMCARE-2 was used to assess family satisfaction. Data were collected for hospital utilization in the 90 days leading up to the intervention and compared to utilization during the pilot. Hospital admissions declined by 52.4%, from 14.7 per 30 days to 7 per 30 days (p = 0.001). Hospital days decreased by 53.8%, from 86.7 per 30 days to 40 per 30 days (p = 0.04). Total ICU usage decreased 100%, from 9.7 per 30 days to 0 per 30 days (p = 0.01). Overall symptom burden decreased, and 40% of patients had a change in code status or advance directives. This HBPC program significantly reduced hospital admissions, total hospital days and ICU utilization for the participants while reducing symptom burden. Expanding this HBPC program would provide high quality care to patients and cost savings to the partnering hospital. Based on average hospital costs of HF admissions in NC, this could represent a savings of up to $8,000 per patient for this 30-day period.