Center To Advance Palliative Care Research Articles

Palliative Care Referral Patterns and Implications for Standardization in Cardiac ICU.

Evidence suggests that pediatric palliative care involvement (PPC) is beneficial to medically complex patients. Historically, PPC involvement has been overlooked or delayed and varies by institution but PPC awareness has increased in cardiovascular ICUs (CVICU) and so we investigated frequency and timeliness of PPC referral for patients dying in ICU. Retrospective study of pediatric cardiac patients experiencing death in ICU to review PPC presence and timing of initial PPC, most recent PPC, and interventions, therapies, CPR, and presence of do-not-resuscitate DNR discussion. Fifty-four patients died during a 5-year period aged 11d-17y (54% male). PPC involvement occurred in 40/54 (74%). Of those patients without PPC, the Center to Advance Palliative Care (CAPC) guidelines would have supported PPC in 11/14 (79%). DNR discussion was more likely in PPC patients (63% vs 14%; p = 0.0011), though often only on DOD. Comparing prior to DOD, PPC patients were still more likely to have DNR discussion (55% vs 0%; p = 0.0003). PPC patients were no less likely to have CPR on DOD (28% vs 43%, p = 0.29). PPC occurred frequently in patients experiencing death in CVICU. However, frequently the initial PPC occurred within a week or day of death. Patients without PPC would often qualify under published guidelines. Standardization, timing, and patient identification for PPC will expand efficacy in CVICU.

Instruments for the identification of patients in need of palliative care in the hospital setting: a systematic review of measurement properties.

The objective of this review was to provide a comprehensive overview of the measurement properties of the available instruments used by clinicians for identifying adults in need of general or specialized palliative care in hospital settings. Identification of patients in need of palliative care has been recognized as an area where many health care professionals need guidance. Differentiating between patients who require general palliative care and patients with more complex conditions who need specialized palliative care is particularly challenging. We included development and validation studies that reported on measurement properties (eg, content validity, reliability, or responsiveness) of instruments used by clinicians for identifying adult patients (>18 years and older) in need of palliative care in hospital settings. Studies published until March 2020 were searched in four databases: Embase.com, MEDLINE (Ovid), PubMed, and CINAHL (EBSCO). Unpublished studies were searched in Google Scholar, government websites, hospice websites, the Library Network of Western Switzerland, and WorldCat. The search was not restricted by language; however, only studies published in English or French were eligible for inclusion. The title and abstracts of the studies were screened by two independent reviewers against the inclusion criteria. Full-text studies were reviewed for inclusion by two independent reviewers. The quality of the measurement properties of all included studies were assessed independently by two reviewers according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Out of the 23 instruments identified, four instruments were included, as reported in six studies: the Center to Advance Palliative Care (CAPC) criteria, the Necesidades Paliativas (NECPAL), the Palliative Care Screening Tool (PCST), and the Supportive and Palliative Care Indicators Tool (SPICT). The overall psychometric quality of all four instruments was insufficient according to the COSMIN criteria, with the main deficit being poor construct description during development. For the early identification of patients needing palliative care in hospital settings, there is poor quality and incomplete evidence according to the COSMIN criteria for the four available instruments. This review highlights the need for further development of the construct being measured. This may be done by conducting additional studies on these instruments or by developing a new instrument for the identification of patients in need of palliative care that addresses the current gaps in construct and structural validity. PROSPERO CRD42020150074.

Palliative Care Specialist Access is Associated With Rankings of Hospital Quality

ContextIncreasing evidence has shown that access to specialty palliative care, particularly outpatient palliative care clinics, can yield improved health outcomes and be a marker of hospital quality. ObjectiveTo determine whether an association exists between access to specialty palliative care programs and hospital rankings found in the 2020-2021 U.S. News & World Report Best Hospitals. MethodsThis study used publicly available data from the Center to Advance Palliative Care (CAPC) Provider Directory to determine access to in-patient and out-patient palliative care in the 2020-2021 U.S. News & World Report Best Hospitals Rankings. Descriptive statistics and chi-squares were performed. Data were also analyzed across the four U.S. Census Bureau regions (Northeast, South, Midwest, West). ResultsAround 100% of the Top 20 hospitals include hospital-based palliative care consultation teams, and 95% offered outpatient palliative care. Of the second cohort of 83 hospitals, 99% offered inpatient palliative care, and 65% offered outpatient palliative care. Of the third cohort of 75 hospitals ranked, 96% had inpatient palliative care services, while only 41.3% offered outpatient palliative care. This represents a significant association between rank position and access to outpatient palliative care (P < 0.01). Ranked hospitals also have significantly higher access to hospital-based palliative care teams compared to the national prevalence rate (P < 0.01). ConclusionThese findings reflect the association of access to specialty palliative care with USNWR rankings for hospital quality. Further study is necessary to determine the specific influence of access to palliative care and USNWR rank position.

Use of an Online Palliative Care Clinical Curriculum to Train U.S. Hospital Staff: 2015-2019.

Background: Most clinicians in the United States do not receive pre-professional education in pain and symptom management, communication skills, and caregiver support. The use of these skills by clinicians improves the quality of care for persons living with serious illness and enables the specialty-trained palliative care workforce to focus on patients whose needs are most complex. Objective: To review current trends in hospital use of the Center to Advance Palliative Care (CAPC) online clinical training curriculum. Description: Launched in 2015, CAPC clinical curriculum educates clinicians in the knowledge and skills necessary to improve care for patients with serious illness. CAPC currently offers 43 clinical courses and 4 Designations in recognition of successful completion of training by topic. Results: From January 15, 2015, to August 31, 2019, 26,535 clinicians working in hospitals completed 172,684 clinical courses. Registered nurses represented half of learners, and advanced practice providers were most likely to seek Designation. Physicians made up 22% of all learners; 85% of physician learners came from specialties beyond palliative care. Two of every five U.S. hospitals with more than 300 beds had at least one learner. In post-course evaluations, 84% reported that they will make practice changes as a result, and 70% reported that the content was new. Conclusions: The CAPC clinical curriculum is a widely used and valued method for education in clinical skills specific to the care of people living with serious illness. Findings suggest that an increasing number of hospital leaders recognize the importance of these skills in caring for patients with serious illness and support the necessary training.

Social Work Training in Palliative Care: Addressing the Gap.

As people live longer with chronic disease and serious illness in the U.S., palliative care teams are called upon to support patients and their families. Social workers are an integral part of the palliative care interprofessional team, and yet there are disproportionately few training programs for social workers who wish to specialize in this area. The curriculum of a post-graduate palliative care training program for social workers should be based on the current standards for palliative care and social work, as described by the National Association of Social Workers (NASW), Council for Social Work Education (CSWE) and the Center to Advance Palliative Care (CAPC). Trainees should develop skills to care for patients who have chronic or life-limiting illness, patients who are nearing their end of life, patients who are in the active dying phase and their families around end of life planning, medical decision making, grief and bereavement. A post-graduate social work training program that aims to prepare social workers to work in the field of palliative care should consist of clinical rotations at multiple sites, robust didactic curriculum and clinical supervision. Interprofessional learning is necessary and training should include opportunities for scholarly work, quality improvement activities, leadership, and teaching. Post-graduate training programs in palliative care will prepare future social workers to be experts in a sub-specialty skill set to meet the needs of people living with chronic disease. These needs and opportunities call on the social work profession to take action to develop post-graduate training programs in palliative care.

AAHPM Collaborations in the Field: Mapping Community Palliative Care and Modernizing the EDRS System (FR450)

•Describe the current status of the Mapping Community Palliative Care project goals.•Understand how to register a new program on the Mapping Community Palliative Care website.•Summarize key goals and progress of the Next Generation Electronic Death Registration System (EDRS). AAHPM collaborates with multiple partners across the country, and this session will review two such collaborations. First, the Academy works with the Center to Advance Palliative Care (CAPC) and the Mapping Community Palliative Care project. Currently over 2,000 community palliative care providers are included – is yours one of them? Presenters will review current status of this project, how information being collected is being used, and answer your questions. Second, the Academy works with the Centers for Disease Control and Prevention to update the Next Gen Electronic Death Registry System (EDRS). Presenters will review goals and current status of this project, and answer any questions.

Overcoming Barriers to Growth in Home-Based Palliative Care.

Home-based palliative care fills a critical gap between acute care (during crises) and hospice care for seriously ill patients. As of 2018, home-based palliative care capacity in the United States has not scaled to meet patient needs. The Center to Advance Palliative Care (CAPC) conducted a needs assessment to catalog and analyze barriers to growth in the field of home-based palliative care. Home-based palliative care program leaders were surveyed and interviewed to elicit information about program characteristics, barriers to meeting national palliative care quality standards or to program growth, and essential elements of program sustainability. Home-based palliative care program leaders cited their major challenges as being: a lack of clarity on the applicability of national standards to home-based programs, a lack of sustainable financing methods for home-based palliative care, and lack of awareness of existing support resources for program design and leadership development. Home-based palliative care programs will benefit from improved professional awareness of national quality standards and existing technical assistance. New prospects for alternative payment models that allow for sustainable interdisciplinary home-based care represent a promising opportunity for the field.

Coding and Billing Jeopardy—Play with the Experts (FR477)

•Identify the importance and rules for capturing reimbursement from three sites of community-based palliative care eligible for reimbursement.•Delineate Evaluation and Management and Time-Based service codes, including the benefits and consequences of each, including the appropriate use of Advance Care Planning codes.•State billing and coding resources. Payment for services with precise billing and coding systems is essential for revenue for palliative care programs in the community. An organization’s billing and coding system sets the foundation for reimbursement from Medicare, Medicaid, and private insurance—and ultimately the budget. Accuracy and quality of billing documentation and submission is essential, as well as monitoring code changes. Through an interactive and engaging process, this session will provide a review of the potential patient encounters eligible for billing as well as accurately capturing the delivery of services. An interdisciplinary palliative care panel—a coding expert, a palliative physician, and a palliative nurse practitioner—will provide discuss billing and coding essentials from across the spectrum. Using a game format, the session will move through a face paced look at common quandaries, pitfalls, and myths about billing and coding. Participants will learn the importance of documentation supporting codes, the benefits and consequences of Evaluation and Management and Time-Based codes, and the appropriate use of Advance Care Planning codes. Resources from the Center for Medicare and Medicaid Services (CMS), Medicare Learning Network (MLN), Center to Advance Palliative Care (CAPC), Hospice and Palliative Nurses Association (HPNA), American Academy of Hospice and Palliative Medicine (AAHPM) and National Hospice and Palliative Care Organization (NHPCO) will be highlighted. The hour will conclude with an interactive Q & A session, and useful "take home" materials.

Education of residents in palliative and hospice care.

118 Background: Patients with chronic advanced illness have a heavy burden of physical and emotional symptoms. In addition to these symptoms, social and spiritual supports are fundamental tenets of palliative care (PC). PC is most effective when delivered early and when routine reassessments are undertaken. Ideally, it is woven into the daily practice of all practitioners. However, current medical education has far too little education around this vital discipline in their curricula. We hypothesized that a single palliative medicine didactic experience would increase practitioners’ familiarity with core concepts of PC. Methods: Palliative care education was delivered as a single interactive lecture for 27 Internal Medicine residents. Information was primarily derived from resources from the Center to Advance Palliative Care (CAPC). The lecture focused on the definition of PC, optimal symptom management and support structures in palliative medicine, and how palliative medicine differs from hospice care (HC). An online questionnaire with ten questions was used to assess pre- and post-lecture knowledge of fundamentals of this discipline. Results: 27 residents participated in the pre-test and 23 participated in post-test. The overall pre-test score was 70% and the post-lecture score was 77%. The biggest difference was seen in the comfort level of first year residents in referring patients to PC and the purpose of PC. Residents had good baseline knowledge of when to refer to HC and the purpose of HC. Conclusions: A single, interactive lecture based on the fundamental tenets of hospice and palliative medicine can improve residents’ knowledge of this discipline. [Table: see text]

Determining the need for palliative care in the emergency department: A feasibility study

Background: According to the Centers for Disease Control and Prevention (CDC), there are over 136 million emergency department (ED) visits annually with increasing use and overcrowding of the ED. The ED’s fast paced, often aggressive treatment nature can provide considerable obstacles to achieving desired benchmarks of quality patient and family centered care that shows improved outcomes along with high levels of satisfaction. Recognizing the need for palliative care (PC) in emergency medicine to facilitate better care, the Center to Advance Palliative Care (CAPC) developed the Improving Palliative Care in Emergency Medicine (IPAL-EM) Project. Methods: A retrospective review of an integrated data repository (IDR) was completed to determine the feasibility, design, and implementation of a PC protocol in the ED of a large, academic Level I Trauma Center. The IPAL-EM Project’s recommendations were explored as we targeted trauma-alert and traumatic intracerebral hemorrhage (ICH) patients. Results: The protocol identified 719 patient encounters over an eight month time-frame that would have triggered an ED initiated PC consultation. Using Meier’s average per-patient per-admission net cost savings related to PC of $2,659 per encounter, there was a potential for over $1.9 million in savings for the facility. Conclusions: PC has demonstrated numerous benefits in various healthcare settings. Studies describing PC in the ED are limited. Furthermore, its culture was not viewed as conducive to PC incorporation. However, future studies investigating the impact of PC on length of stay (LOS), symptom management, patient/family satisfaction, and costs of care is critical.

A State-Level Assessment of Hospital-Based Palliative Care and the Use of Life-Sustaining Therapies in the United States.

It is unknown how the prevalence of hospitals with palliative care programs (PCPs) at the state level in the United States correlates with the treatment of critically ill patients. We examined the relationship between state-level PCP prevalence and commonly used treatments for critically ill patients as well as other public health metrics. We compiled state-level data for the year 2011 from multiple published sources. These included the poverty rate from the U.S. Census, public health measures such as the number of primary care physicians per 100,000 persons from America's Health Ranking website, and state-level rates for a series of validated ICD-9 (International Classification of Diseases, 9th Revision) procedure codes used for critically ill patients (e.g., prolonged acute mechanical ventilation [PAMV]) from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality. State-level percentages of PCPs came from a published report by the Center to Advance Palliative Care (CAPC). We used the Kruskal-Wallis test and Pearson's correlation coefficient for statistical inference. State-level poverty rates were negatively correlated with the percent of hospitals with PCPs: r = -0.39, p = 0.005. States with more hospital-based PCPs had significantly lower rates of PAMV, tracheostomies, and hemodialysis but higher rates of nutritional support than states with fewer PCPs. States with more poverty and/or at high risk for delivering inefficient health care had fewer hospital PCPs. Hospital-based PCPs may influence the frequency of some interventions for critically ill patients.

Evaluation of Hospital-Based Palliative Care Programs

This study evaluated current hospital-based palliative care programs using recommendations from the Center to Advance Palliative Care (CAPC) as a framework. Seven hospitals located in Buffalo, New York were included based on the existence of a hospital-based palliative care program. Data was collected from August through October of 2013 by means of key informant interviews with nine staff members from these hospitals using a guide comprised of questions based on CAPC's recommendations. A gap analysis was conducted to analyze the current state of each hospital's program based upon CAPC's definition of a quality palliative care program. The findings identify challenges facing both existing/evolving palliative care programs, and establish a foundation for strategies to attain best practices not yet implemented. This study affirms the growing availability of palliative care services among these selected hospitals along with opportunities to improve the scope of services in line with national recommendations.

Examination of the Interrater Reliability of a Palliative Care Assessment Tool in Patients at Hospital Admission

Early identification of palliative care needs in hospitalized patients is essential for clinicians to provide timely and effective interventions at the specific level of palliative care required by the patient and their family. The Center to Advance Palliative Care (CAPC) developed criteria to ident

New Palliative Care Guidelines Stress Certification, Diversity

New Palliative Care Guidelines Stress Certification, Diversity

Optimal Cancer Care: Concurrent Oncology and Palliative Care

Optimal cancer care requires the integration of palliative care into practice. This concept has been endorsed by widely respected organizations, including the WHO, the Institute of Medicine (IOM), the European Society of Medical Oncology (ESMO), and ASCO. With the aging of the population, the associated increase in the incidence of cancer, and the growing number of patients living with complications of cancer and its treatment, palliative care is more important than ever. Despite strong recommendations and growing clinical data supporting the benefits of concurrent palliative care and cancer care, resistance continues. Why is this? What are the barriers and, more importantly, what are the solutions? A group of international experts met in Rome, Italy, to review the current status of concurrent palliative and oncology care in different countries and to address these questions. This supplement is a product of these discussions. The group focused on the following key issues in the integration of palliative care into cancer care: development of a standard definition of palliative care and its component parts; models for care delivery; standardization of tools for patient assessment; educational programs designed to meet the needs of health care professionals; and the importance of developing best practices in symptom management using breakthrough pain management as an example (see article by Von Roenn et al in this supplement). Palliative care is an essential component of excellent cancer care. All patients and families deserve patient-specific information about their illness, its treatment, and natural history. All patients should expect cutting-edge cancer treatment in the context of their personal goals, with attention to their physical, psychological, social, spiritual, and practical concerns. This type of care is best provided by an interdisciplinary team focused on the relief of suffering in all of its dimensions. Although this view is widely accepted, the group identified continued confusion about the definition of palliative care (see article by Glare in this supplement). In different parts of the world, the term palliative care refers to care at the end of life only, and in others, to patient- and family-centered care across the trajectory of illness, regardless of prognosis. The differences in definition are primarily ones of timing (when in the course of illness the care is provided) as opposed to differences in the components of excellent palliative care. The term supportive care, rather than palliative care, has been suggested as an alternative name because it might be less distressful to patients, families, and health care professionals. However, I suspect the distress is based on the widespread misconception (at least in the United States) that referral to palliative care means that the patient is dying. If supportive care replaced the term palliative care, the former would take on the same meaning unless we work to educate the public about the benefits of this care, no matter what we label it. Results of a recently completed project of the Center to Advance Palliative Care (CAPC) support this contention and suggested language that might reduce this distress. 1 In collaboration with the American Cancer Society, the CAPC commissioned a study to explore the awareness and understanding of palliative care by consumers and policymakers and to test language, terminology, definitions, and messaging that might be better used in discussions of palliative care with the public. While evaluating American consumers, the researchers discovered that the term palliative care had little or no meaning to most patients, there was a general lack of awareness that palliative care services exist, and physicians tended to equate palliative care with end-of-life

Hospital Palliative Care Programs Raise Grade to B in New Report Card on Access

ARECENT SURVEY THAT GRADED THE 50 states on access to palliative care bumped the United States up a grade, to a B from a C in 2008. Despite the rapid growth of hospitalbased palliative care programs, the survey nonetheless reports ongoing barriers to access: too few trained professionals, knowledge gaps in symptom relief, and the need for new reimbursement models. The 2011 survey, carried out by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC) at the Mount Sinai School of Medicine, both in New York City, examined data taken primarily from the American Hospital Association Annual Survey Database for 2009. Of the 2489 hospitals with 50 or more beds surveyed, 63% had palliative care programs. Of hospitals with more than 300 beds, 85% had palliative care teams (http://www.capc.org /reportcard/). Seven states and the District of Columbia received an A grade, meaning that more than 80% of hospitals surveyed in those states reported having palliative care programs. Twenty-five states received B grades, indicating that 61% to 80% of hospitals had such programs. C’s went to 12 states where 42% to 60% of hospitals had programs; 4 states received D’s, with programs in 28% to 38% of hospitals; and F’s went to Delaware and Mississippi, each with 20% of hospitals surveyed having programs. States that made substantial gains since 2008 included Nevada, where the percentage increased from 23% to 69%; Mississippi, up from 10% to 20%; and Alabama, up from 16% to 28%. Hospitals with 300 or more beds were the most likely to have palliative care programs, while for-profit, public, and sole community provider hospitals were the least likely. Access to palliative care also varied widely among various regions of the country. For example, 73% of hospitals with 50 or more beds in the Northeast reported having programs, compared with 51% in the South. Lead author R. Sean Morrison, MD, director of the NPCRC, said that just as every hospital has an emergency department and intensive care units or beds, so should they have palliative care services for adults and children with serious illnesses. “I think that by 2020, we will be at a point where 100% of our 300-plusbed hospitals will have a palliative care team, and [more than] 80% of our smaller hospitals will have a palliative care [program],” said Morrison. He said data show that palliative care can cut hospital costs and improve the quality of care. In a study of Medicaid patients in 4 New York hospitals, Morrison and his colleagues showed that patients who received palliative care incurred $6900 less in a given admission than those who received usual care (Morrison RS et al. Health Aff [Millwood]. 2011;30[3]:454-463). If every New York hospital with 150 or more beds had properly trained teams that provided palliative services within routine patient care, the study estimated statewide Medicaid savings between $84 million and $252 million annually within 5 years. A study of 151 patients with metastatic non–small cell lung cancer, which usually has a prognosis of less than 1 year, showed that those who received palliative care had less depression and better scores on a quality-of-life scale than those who received usual care. Patients who were given palliative care early in their illness received less aggressive end-of-life care, but their median survival was 2.7 months longer than patients receiving usual care (Temel JS et al. N Engl J Med. 2010; 363[8]:733-742). According to the CAPC, an estimated 90 million Americans have serious or life-threatening illnesses. That number is expected to double in 25 years as baby boomers age. About 6 million people in the United States currently could benefit from receiving palliative care. Since 2000, the prevalence of palliative care teams in US hospitals with at least 50 beds has increased by 138%, according to the survey. That growth is among the factors that prompted the Joint Commission, which accredits about 4500 US hospitals, to launch a new cer-

The National Palliative Care Research Center and the Center to Advance Palliative Care

The elimination of suffering and the cure of disease are the fundamental goals of medicine. While medical advances have transformed previously fatal conditions such as cancer and heart disease into illnesses that people can live with for many years, they have not been accompanied by corresponding improvements in the quality of life for these patients and their families. Living with a serious illness should not mean living in pain or experiencing symptoms like shortness of breath, nausea, or fatigue. Yet, multiple studies over the past decade suggest that medical care for patients with advanced illness is characterized by inadequately treated physical distress; fragmented care systems; poor communication between doctors, patients, and families; and enormous strains on family caregiver and support systems. Palliative care is interdisciplinary care focused on relief of pain and other symptoms and support for best possible quality of life for patients with serious illness, and their families. It is appropriate at the point of diagnosis of a serious illness. It goes beyond hospice care to offer patients and their families treatments focused on improving quality of life while they are receiving life-prolonging and curative treatments. Palliative care programs have been shown to reduce symptoms, improve doctor-patient-family communication and satisfaction with care, as well as enhance the efficiency and effectiveness of hospital services. In the last 5 years alone the number of palliative care programs has more than doubled. This growth is in response to the increasing numbers and needs of Americans living with serious, complex and chronic illnesses, and the realities of the care responsibilities faced by their families. In order to ensure that all persons with serious illness and their families receive the quality of care they deserve, palliative care must become an integral part of the U.S. healthcare landscape. Specifically, persons facing serious illness and their families must know to request palliative care, medical professionals must have the knowledge and skills to provide palliative care, and hospitals and other healthcare institutions must be equipped to deliver and support palliative care services. The Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC) are accomplishing this three-part mission by working in partnership to: 1) Develop research to serve as the knowledge base for quality clinical care and the foundation on which to build palliative care programs and systems; 2) Disseminate this knowledge to patients, families, professionals, and institutions throughout the United States and ensure that it is integrated within mainstream healthcare; and 3) Influence and collaborate with policy makers , regulatory bodies, and federal funding agencies to ensure that the healthcare infrastructure supports the continued growth and development of palliative care.

America's Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals

Over the last 10 years the number of palliative care teams in hospitals has more than doubled. Yet despite the myriad benefits of palliative care, as well as its recent growth, much more progress is needed. Millions of Americans facing serious illness do not yet have access to palliative care from the point of diagnosis throughout the course of illness. Availability also varies considerably by region and by state. The following findings, taken from America's Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals (www.capc.org/reportcard/), represents an update of the previous 2008 Report Card issued by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC). The report highlights the current prevalence of hospital palliative care in the United States by examining variation in access to palliative care at the state level.

A Statewide Status Report on Hospital-Based Palliative Care Programs

The Center to Advance Palliative Care (CAPC) has attempted to identify hospitals providing palliative care services in its 2008 state-by-state report, and currently through the web-based Palliative Care Provider Directory of Hospitals. To augment those efforts for one state, a survey was conducted to explore how many hospitals reported having palliative care services and how well those services met consensus recommendations. Survey results show that a majority (82 %) of hospitals continue to lack palliative care programs, and even knowledge of palliative care was limited. More education and training for physicians, health care staff, and the general public was recommended strongly.

Using Metrics to Grow Your Palliative Care Program (527)

Objectives 1. Describe the essential operational, customer, and clinical metrics that a non-hospice palliative care program should measure. 2. Examine a range of data collection tools that best meet the needs of small/medium/large palliative care programs. 3. Design a process to interpret and report metric data that will maximize opportunities for program sustainability and growth. Data collection and analysis are vital for strategic planning, quality improvement, and demonstration of palliative care program impact to hospital administrators, private funders, and policymakers. Global program standards and preferred practices have been established by the National Quality Forum, the Center to Advance Palliative Care, and the National Consensus Project. To provide more detailed information to palliative care program directors, the Center to Advance Palliative Care (CAPC) began a consensus process to outline essential Non-Hospice Palliative Care Program operational, clinical, and customer metrics. Operational metrics are those designed to capture key demographic data about a consultation service or inpatient unit. Clinical metrics are measures of patient care, such as pain and symptom management. Customer metrics refer to data about clinical quality from key palliative care stakeholders, such as families or referring clinicians. The CAPC consensus process has been completed and published in the Journal of Palliative Medicine. This workshop will help attendees operationalize the CAPC consensus recommendations. Learners will review the consensus recommendations and then discuss available measurement tools and techniques that can be used to gather, interpret, and report their measurement data. Finally, learners will apply this information to develop a measurement Action Plan for their individual programs.