Trends in Hospital-Based Specialty Palliative Care: Insights from a National Palliative Care Quality Improvement Collaborative (S866)

Abstract

1.Describe at least two trends in processes of care provided by inpatient palliative care (PC) teams over time.2.Describe one major change in a clinical outcome achieved by inpatient PC teams over time.3.Discuss how these trends relate to evolving expectations of and norms within the field. The field of palliative care (PC) is growing and evolving rapidly in response to increased demand and recognition of its benefits. Describe how processes of care and outcomes achieved by inpatient PC teams have changed over time. Data for this study were extracted from the Palliative Care Quality Network database on 03/06/2018 and pertain to 135,197 patients referred to 88 inpatient PC consult teams between 01/01/2013 and 12/31/2017. The most common diagnoses leading to inpatient PC consult were cancer (32.0%, range between teams: 11.3%–93.9%), cardiovascular disease (13.2%, 0%–29.0%), and pulmonary disease (11.3%, 0%–26.0%). The percentage of referred patients with cancer decreased between 2013 and 2017 (39.0% to 30.0%, p<0.0001), while there was an increase in the percentage of patients with cardiovascular disease (12.0% to 14.0%, p<0.0001) and pulmonary disease (10.0% to 12.0%, p<0.0001). Most patients were discharged from the hospital alive (78.7%, range between teams: 44.7%–99.4%), and the percentage of patients discharged alive increased over time (75.0% to 80.0%, p<0.0001). Between 2013 and 2017, there was a substantial decrease in hospice referrals (46.0% to 31.0%, p<0.0001) and an increase in referrals to clinic-based (2.0% to 4.0%, p<0.0001) and home-based PC services (2.0% to 4.0%, p<0.0001). There is wide variation in practice across inpatient PC teams. Overall, teams are seeing more patients with diagnoses other than cancer and are doing so earlier in the course of illness, which may account for lower rates of hospice referral. Teams are connecting slightly more patients with outpatient PC services at the time of hospital discharge.