Hospice Organization Research Articles

The Importance of Providing Training to Informal Caregivers of Hospice Patients: Caregiver Experience With Hospice Care Based on Consumer Assessment of Healthcare Providers & Systems Surveys.

Informal caregivers aid hospice patients at the end of life. Little is known of their preparation and confidence in providing care, and how this relates to experiences of hospice care. Examine factors associated with informal caregivers' rating of home hospice care. Data come from 828 completed CAHPS® surveys mailed between January 2022 and December 2023 from a single non-profit Hospice organization. Multivariate logistic regression analyses examined the independent influence of various aspects of hospice care on ratings of hospice. Nine of every 10 respondents rated hospice care high (9 or 10). Most aspects of hospice care were rated favorably. Nearly all respondents felt the patient was treated with dignity and respect (96%). The measure with the greatest room for improvement was getting help as soon as needed (82% "always"). Multivariate analyses revealed 6 factors that independently predicted overall rating of hospice care. The strongest predictor was always getting help as soon as needed, followed by believing the hospice team cared about the patient. Three measures of caregiver training were significantly associated with higher ratings of hospice care being trained to: safely move the patient, what to do if patient became restless, and on pain medications. When informal caregivers feel trained to assess and manage the symptoms, they rate hospice care more favorably. Greater attention to informal caregiver training and support are imperative to improving hospice care.

Pilot Testing Educational Videos for Black Caregivers Receiving Home Hospice Care.

Black caregivers face distinct challenges in symptom management when providing end-of-life care. Educational interventions may improve caregiver preparedness and competency by providing information on symptom management. This study pilot tested 4 culturally tailored caregiver educational videos about symptom management for Black caregivers receiving home hospice care at a large, urban, nonprofit hospice organization to determine feasibility and acceptability, along with their potential impact on caregiver outcomes. All participants (N = 10) agreed to watch the 4 videos and found the videos to be helpful; 90% (n = 9) shared that they would recommend them to other Black caregivers receiving home hospice care. Total preparedness scores increased from a mean score of 23.5 preintervention to 28.3 postintervention. Caregiver competency scores increased from 13.8 at preintervention to 14.3 at postintervention. Caregivers' comfort and knowledge scores increased from preintervention to postintervention for all 7 end-of-life topics presented in the 4 videos. This study found that it was feasible and acceptable to show Black caregivers culturally tailored educational videos related to issues regarding symptom management. Many found the videos to be helpful and the topics to be relatable. There were trends toward improvement in preparedness and competency. Future studies examining efficacy are needed to determine the impact of this intervention.

Choosing Hospice is Not Giving Up

Choosing Hospice is Not Giving Up

State of the Service: Pediatric Palliative and Hospice Community-Based Service Coverage in the United States.

Background: The pediatric literature describes reliance on community-based organizations for home-based palliative and hospice care for children. Objective: To quantify and describe the inclusion of children in services, staffing, and care scope offered by community-based hospice organizations in the United States. Design and Subjects: This study utilized an online survey distributed to organizational members of the National Hospice and Palliative Care Organization (NHPCO) in the United States. Results: A total of 481 hospice organizations from 50 states, Washington DC, and Puerto Rico responded. Twenty percent do not provide services for children. Nonmetro geographies are less likely to provide services for children. Pediatric services provided include home-based pediatric hospice (57%), home-based palliative care (31%), inpatient pediatric hospice (23%), and inpatient pediatric palliative care (14%). Hospice annual pediatric census is an average of 16.5 children, while palliative care annual census is an average of 36. Less than half (48%) of responding agencies have a team that is dedicated to only pediatric care. Medicaid and the Children's Health Insurance Program are the most common forms of reimbursement, with 13% depicting "no reimbursement" for provision of care for children and many relying on philanthropy coverage. Lack of trained personnel, discomfort, and competing priorities were depicted as the most common barriers. Conclusions: Children remain underrepresented in the extension of care offered through community-based hospice organizations in the United States particularly in nonmetro settings. Further research into strong training, staffing, and reimbursement models is warranted.

Medical decision-making in hospices from the viewpoint of physicians: results from two qualitative studies

BackgroundPhysicians who practice in a hospice are responsible for working with patients and nursing staff to develop a medication plan, monitor symptoms and pain, and adjust medication if necessary. In inpatient hospices in Germany, physicians are part of a multi-professional approach, but not part of the hospice team itself. However, there is no, or hardly any, literature on medical practice in a hospice setting. Therefore, we wanted to know how physicians reflect upon their role in hospice within a multi-professional setting, how they communicate with patients, relatives, nursing staff and other physicians, and what the limitations of these communication processes are.MethodsBy means of two qualitative studies we explored how physicians classify their activities as part of the hospice organization. The study design followed Grounded Theory procedures.ResultsThe physicians named an appropriate interpretation of the patient's wishes as the challenge of everyday practice which can lead to differences of perspective with those involved: with nursing staff, who would prefer an alternative form of medication, with relatives, who do not accept that the patient refuses nutrition, with other physicians, who have a different opinion about appropriate treatment. For physicians, this is all the more challenging as communication with the patient becomes increasingly uncertain due to the patient’s illness. Again and again, medical measures have to be negotiated on several levels.ConclusionMulti-professional organizations that have to deal with differences in perspective handle them by clearly distinguishing areas of responsibility, an aspect that physicians also claim for themselves. For physicians the question arises repeatedly whether they have correctly interpreted the wishes of the patient. They must continuously reassure themselves of the patient's wishes and this presents them with communication challenges not only with the patient, but also with the nursing staff and relatives and, more recently, with their colleagues.

"If We Build It, Will They Come?" A Cohort Study of Family Utilization of a Pediatric-Specific Hospice Home.

Objective: To determine whether families would make use of a pediatric-specific inpatient hospice facility for end-of-life care for children. Background: Location of end-of-life care and death are important considerations when treating children with life-limiting conditions. There is very limited research on utilization of an inpatient hospice facility for end-of-life care if a pediatric-specific facility is available. We examined changes in family utilization of inpatient hospice services with the availability of an inpatient pediatric hospice facility (PHF). Methods: We conducted a retrospective cohort study with data collected on location of end-of-life care and death five years prior to and five years following the opening of a PHF that receives referrals from a large children s hospital in United States. Two data sources from the hospice organization were used: (1) a dataset on origins and outcomes of referrals to pediatric inpatient hospice care and (2) a dataset on location of death for all pediatric patients who had any contact with the hospice system. Chi-square analyses were conducted to assess the associations between the PHF opening and referral outcomes and location of death. Results: Significant results were found with respect to both referral outcomes and location of death. Engagement in inpatient hospice care increased between 2- and 10-fold following the opening of the inpatient PHF. The percent of patients who died in an inpatient hospice unit also increased significantly with the opening of the pediatric facility. Discussion: Results of this study show that providers are more likely to refer, and families are more likely to use inpatient hospice services when pediatric facilities are available. These results are important for establishing an evidence base in support for increasing access to PHFs.

Participatory design and implementation of an organizational plan to address burnout in hospice employees

Hospice professionals face practice challenges that place them at increased risk for burnout. Limited research has reported on organizational efforts to address burnout and reduce work-related stressors with participatory involvement from employee stakeholders. In a large state-wide hospice organization, focus groups were initially conducted by external researchers with mixed groups of interdisciplinary employees to evaluate workplace stressors and to determine team member perceptions relative to burnout and its’ management. The paper reports an innovative multifaceted organizational education strategy that was conceived and implemented in response to the focus group findings to address or remediate work related stressors to support interdisciplinary employees across rural and urban regions who were involved in home or institutional hospice care delivery. Key executive leadership members evaluated and approved the multi-pronged organizational action plan. Interdisciplinary workgroups were formed and tasked with generating practice strategies to address four major areas of employee concern including work-related stressors, technology issues, staff appreciation and recognition, and communication. Implementation of the workgroups and delivery of the workplace changes have practice, education, and research implications. The process of stakeholder engagement with focus group findings to generate solutions may be utilized in other organizations seeking to learn strategies to address workplace stressors and improve employee wellbeing.

Janet L. Langlois (1946–2021)

Janet L. Langlois (1946–2021)

Palliative care organization and staffing models in residential hospices: Which makes the difference?

BackgroundThe number of patients using palliative care services, particularly residential hospices, is increasing. Policymakers are urging these services to reflect on the most effective organizational strategies for meeting patients’ complex care needs. AimTo analyze the predictive power of staffing, structure and process indicators towards optimal control of patients’ clinically significant symptoms over time. DesignSecondary analysis of data from a multicentre prospective longitudinal observational study (PRELUdiHO) collected between November 2017 and September 2018. Setting/participantsAdult patients (n = 992) enrolled in 13 Italian residential hospices. MethodsTwo generalized estimating equations logistic models were built, both with number of hospice beds and length of stay as independent variables as well as, in one case, patient-to-healthcare worker ratios, and, in the other, health professionals’ qualification levels. Dependent variables were six not clinically significant (score<4) symptoms: pain, nausea, shortness of breath, feeling sad, feeling nervous, and ‘how you feel overall’, according to the Edmonton Symptom Assessment System revised (ESAS-r) scale. ResultsThe generalized estimating equations indicators on staff revealed the following ‘optimal’ model: Patient-to-Physician ratio (5.5:1–6.5:1); Patient-to-Nurse ratio (1.5:1–2.7:1); Patient-to-Nurse-Assistant ratio (4.1:1–6.3:1); with the most balanced staff composition including 19% physicians, 23% nurse assistants, and 58% registered nurses; hospice beds (12–25); length of stay (median = 12 days). This model predicted an up to four times greater likelihood of controlling all six ESAS-r symptoms over time. The generalized estimating equations model on the educational level of physicians and registered nurses showed that it was significantly associated with optimal patients’ symptom control during the entire hospice stay. ConclusionsThis study showed the exact skill-mix composition and proportions of palliative care team able to ensure optimal control of patients’ symptoms. The added value of physicians and nurses with a qualification in palliative care in terms of better patient outcomes reaffirmed the importance of education in guaranteeing quality care. Hospices with 12–25 beds, and recruitment methods guaranteeing at least 12-day stay ensured the most propitious organizational environment for optimal management of clinically significant symptoms. The transferability of these results mainly depends on whether the skills of health professionals in our `ideal' model are present in other contexts.Our results provide policymakers and hospice managers with specific, evidence-based information to support decision-making processes regarding hospice staffing and organization. Further prospective studies are needed to confirm the positive impact of this ‘optimal’ organizational framework on patient outcomes.

COVID-19 infection rates early in the pandemic among full time clinicians in a home health care and hospice organization

BackgroundPatient-facing health care workers (HCW) experience higher rates of COVID-19 infection, particularly at the start of the COVID-19 pandemic. However, rates of COVID-19 among front-line home health and hospice clinicians are relatively unknown.MethodsVisit data from a home health care and hospice agency in New Jersey early in the pandemic was analyzed to examine COVID-19 infection rates separately for clinicians exposed to COVID-19-contagious patients, and those without exposure to known COVID-19 contagious patients.ResultsBetween March 5 and May 31, 2020, among home health clinicians providing in-person care, clinicians treating at least one COVID-19 contagious patient had a case rate of 0.8% compared to 15.7% for clinicians with no exposure to known COVID-19 contagious patients. Among hospice clinicians providing in-person care, those who treated at least one COVID-19 contagious patient had a case rate of 6.5%, compared to 12.9% for clinicians with no known exposure to COVID-19 contagious patients. Non-White clinicians had a higher COVID-19 case rate than White clinicians (10.9% vs 6.2%).DiscussionLower rates of COVID-19 infection among clinicians providing care to COVID-19-contagious patients may result from greater attentiveness to infection control protocols and greater precautions in clinicians’ personal lives. Greater exposure to COVID-19-contagious patients prior to patient diagnosis (“unknown exposures”) may explain differences in infection rates between home health and hospice clinicians with workplace exposures.ConclusionClinicians providing in-person care to COVID-19-contagious patients experience lower rates of COVID-19 infection than clinicians providing face-to-face care with no known exposure to COVID-19 contagious patients. Our findings suggest there was a low incidence of potential workplace infections.

Palliative medicine in the emergency department: symptom control and aggressive care

ObjectivesIdentifying the prevalence of palliative care (PC) needs among patients who die at the emergency department (ED) and to assess symptom control and aggressiveness of care.MethodsWe conducted a decedent cohort...

Reducing Hospital Visit Rates in Hospice Patients Using Telemedicine.

The purpose of this project was to examine the impact of accessibility to a provider via telemedicine on emergency department visit rates in adults, 35 years and older, on home hospice and palliative care. Utilizing a quasi-experimental design, 44 adults 35 years and older were educated on Doxy.me telemedicine usage as an intervention. Measures included gender, diagnosis, age, the reason for contact, and outcome (intervention group only); the number of emergency department visits, the number of 911 calls, and the number of discharges/transfers (control and intervention) in the 8 weeks after the evidence-based telemedicine intervention. Statistical analyses were performed to examine the number of emergency department visits and 911 calls preintervention and postintervention among all participants. A total of eight teletechnology calls were documented from a patient or patient caregiver. Among the intervention group, the number of emergency department visits and the number of 911 calls decreased from 12 (54.5%) to one (4.5%) postintervention. Paired-samples t tests show there were statistically significant differences in the number of emergency department visits and 911 calls between the two points in time. In conclusion, a telemedicine hospice care application may benefit a palliative and hospice organization by enhancing patient clinical outcomes and decreasing emergency department visit rates.

Facilitating inter-professional integration in palliative care: A service ecosystem perspective

A paradigm shift toward healthcare inter-professional collaboration is leading to searches for ways to better facilitate integration. However, policy rhetoric often fails to acknowledge the complexity of healthcare service systems, and the difficulties involved in achieving successful collaborations. Consequently, more research is called for. We utilize the concept of a service ecosystem, a perspective currently prominent in service science, which is transforming the ways service systems are studied. This research aims to examine palliative care provision through a service ecosystem lens in order to uncover previously unidentified insights and opportunities for improvement. The palliative care ecosystem under study encompasses a defined geographical area of the UK. Data comprises pathographies (i.e., narratives of illness) with patients and their families (n = 31) and in-depth interviews with a variety of palliative care providers (n = 21), collected between 2017 and 2018. Capability issues comprising collaboration, coordination, and resource integration, together with communicating value all emerged as common themes impacting palliative care services. Taking a service ecosystem perspective, we also found shared intentionality for better integration and collaboration, with a desire among palliative care providers for the ecosystem's hospice organization to take the role of leader and facilitator. Acting on these findings, we demonstrate the ways new institutional arrangements provide a foundation for value cocreation. We make a contribution to the burgeoning service ecosystem literature which currently lacks empirical insights, particularly in health. We argue that in complex service systems such as healthcare, the focus must be on service design rather than organizational design, approached from the perspective of aggregation of service providers. We demonstrate empirically how reconfiguring resources and developing new institutional arrangements at the meso level can change micro-macro level interaction, enabling the emergence of new and enhanced value cocreation in palliative care.

Feasibility, Acceptability, and Outcomes of a Yoga-Based Meditation Intervention for Hospice Professionals to Combat Burnout.

(1) Background. This research examined the feasibility, acceptability and outcomes of delivering a 6-week yoga-based meditation intervention to clinical teams of hospice professionals (HPs) at a large non-profit hospice organization. The intervention was designed to increase mind-body integration and combat burnout. This article was written for different audiences, including research scientists who study interoception, burnout, meditation, or yoga, designers of meditation interventions, and hospice organizations looking for ways to mitigate HP burnout. (2) Methods. The intervention was launched within clinical teams, beginning with a half-hour online introduction to the program and exposure to the week 1 meditation at each team’s monthly all-staff meeting. Throughout the program, HPs could access the meditations on their own via their workplace computers, tablets, and smartphones. Online pre- and post-intervention surveys were submitted by 151 HPs, 76 of whom were exposed to the intervention and completed both surveys. The surveys assessed burnout using the Professional Fulfillment Index and mind-body integration using the Multidimensional Assessment of Interoceptive Awareness scales. (3) Results. Two-thirds of HPs who were present at a staff meeting where the program was introduced went on to do a meditation on their own at least once. Half of HPs expressed a desire to continue with access to the meditations after the 6-week program ended. Due to COVID-19 work from home restrictions, three-fourth of HPs did a meditation at home, 29% in a car between patient visits (not while driving), and 23% at the office. Higher interoceptive awareness was significantly related to lower burnout, particularly lower work exhaustion. Meditation frequency was significantly related to higher interoceptive awareness but not to burnout. Interpersonal disengagement was rare and temporary. (4) Conclusions. Findings showed that the yoga-based meditation intervention was feasible and acceptable and associated with higher interoceptive awareness. The results point to a role for interoceptive awareness in reducing the risk for burnout.

Identifying Areas of Improvement for Care of Hospice-Enrolled Patients Presenting to the Emergency Department (QI720)

1.Describe the current framework for management of hospice-enrolled patients presenting to the Emergency Department.2.Identify how many patients enrolled in a large hospice organization present to the Emergency Department over a 2-month period and most common chief complaints.3.Describe a potential intervention to assist hospice-enrolled patients experiencing perceived emergencies at home or in congregate settings. While there are some emergencies that require hospice-enrolled patients to present to the Emergency Department (ED) (such as lacerations or equipment malfunction), some hospice-related and predictable emergencies may be equally or superiorly treated at home or inpatient hospice (such as shortness of breath or pain). Although Emergency Medicine and Hospice and Palliative Medicine physicians have opinions on why hospice-enrolled physicians present to the Emergency Department, there is little research on the most common reasons leading hospice-enrolled patients presentation to the ED. To identify the most common reasons hospice-enrolled patients in a large hospice organization present to the Emergency Department and design chief complaint-focused interventions to avoid undesired and unnecessary ED visits. Using triage notes and input from hospice nurses and physicians, I identified hospice-enrolled patients who presented to the ED over between January 1, 2020 and February 28, 2020. Over a 2-month period, 44 hospice-enrolled patients presented to the ED. The most common hospice diagnoses were cancer, cardiovascular disease, COPD, Alzheimer’s disease and cirrhosis. 26 patients came from home and 18 came from a nursing facility. 18 out of the 44 patients presented after a fall. The other presentations were for respiratory issues (7), gastrointestinal issues (6), equipment malfunction (4), agitation or altered mental status (4), pain (3), and rash (2). ED presentation was relatively common over a 2-month period among our hospice-enrolled patients. Falls were by far the most common reasons for presentation. This was not a commonly identified emergency in the literature related to hospice-enrolled patients presenting to the ED. In response to this, I created an Emergency Plan sheet related to falls. In the future, this will be given to patients upon enrollment.

Macy Catheter: Integration and Evaluation in a Hospice Setting to Provide Symptom Relief During End-of-Life Care.

Provision of high-quality end-of-life care in a cost-effective work environment is the aim of all hospice organizations. This opportunity can be negatively affected when there is a limited supply of parenteral narcotics or administration routes are either not functional or fail to control symptoms. To combat these challenges, including a shortage of available parenteral narcotics, staff at a hospice organization adopted the use of a rectal catheter to deliver oral medications that were readily available. The implementation of a rectal catheter resulted in better control of symptoms, fewer titrations, and improvement in pain control and/or symptom management needs during end-of-life care management.

Simoultaneous Home Palliative Care in Onco-Hematological Patients: An Italian Single Institution Experience

Introduction Despite their high symptomatic burden, frequent quality of life impairment, and possible incurable evolution, patients (pts) with hematological malignancies are hardly ever referred to palliative care (PC) settings. The main reasons explaining the limited resort to PC specialists by hematologists include frequent transfusion need, common infectious complications, possible unpredictable disease course and the growing availability of new and potentially active therapeutic opportunities. Additional factors may include inadequate awareness of the PC landscape, the lack of PC specialist within the hematologic care team and their scarce attitude to address the end-of-life issues with pts and families. Lastly, an intensive psychological bond between pts and their hematologists might contribute to the patient's natural preference of the hospital also for the care of terminal disease. Nonetheless, growing reported experiences confirm an overall worse end-of-life managing outside of the PC specialized settings. Methods Starting from 01/2014, in our Institution we started a collaboration with a specialized PC team including both hospice and home settings organization for onco-hematological pts. Aiming to investigate the feasibility of the integration of simultaneous home PC with active and supportive therapies, including transfusion support, for the treatment of pts affected by advanced phase hematological malignancies, we retrospectively collected disease and clinical information from clinical charts of pts who were referred to PC. The database included most relevant information with regard to PC intervention, including evaluation of end-of-life managing. Data were analyzed by descriptive statistics. Results From 01/2014 to 02/2020, 79 pts (52% males) with an onco-hematological disease were referred to home PC. Since 14 pts (18%) required multiple phases of PC assistance during their disease history (12 pts were referred twice and 2 pts three times, respectively), a total of 95 palliative care pathways were identified. Pts characteristics at PC referral are listed in table 1. Median age at the time of referral to PC was 82 years (range 40-96). Onco-hematological disease was acute leukemia (AL) in 25%, multiple myeloma (MM) in 32%, lymphoma in 25% and myelodysplastic syndrome (MDS) or myeloproliferative neoplasms (MPN) in 19% of patients. 95% of pts were informed of their diagnosis, but only 25% of pts were fully aware of the prognosis. With 75% of pts permanently living with a relative and 4% living alone, family framework was considered fully appropriate in 47% of pts, acceptable in 42% and scarce in 11%; altogether, a professional caregiver was present in 39% of pts. At the home PC referral, only 24% of pts was self-sufficient in daily activities, even though 78% was totally conscious. Overall, 36% of the pts complained at least 3 relevant symptoms among pain, hallucination, confusion, agitation, sleep disorders, dyspnea, nausea, asthenia, anxiety and psychological distress. Median duration of the home PC was 36 days, widely ranging from 1 up to 304 days. Simultaneous PC occurred in 44 pts (56%), while 35 pts (44%) continued a primarily oral hematological therapy. 39 pts (49%) received blood components transfusions in the hospital during the home PC assistance, in accord with the PC specialist. Death eventually occurred at home in 58 patients (73%), in hospice in 8 patients (10%), and in hospital in 10 patients (13%) [Table 2]. Conclusions The population referred to our home PC organization included pts with various hematological malignancies. During home PC assistance, 56% of the pts continued to attend our onco-hematology department for monitoring visit during an ongoing oral hematological therapy (44%) and/or for blood transfusion support (49%). With the vast majority of pts eventually deceasing at home or in hospice, the integration of home PC both with active hematology treatment and transfusion support appears to be feasible, meaningfully improving end of life management of patients with advanced hematological malignancies. The experience of multiple home PC pathways during the disease course in a proportion of patients offers an interesting perspective for a possible planning of temporarily palliative support in onco-hematological pts, who sometimes could still strikingly benefit of active treatments, even in very advanced phase of their disease. Disclosures No relevant conflicts of interest to declare.

Palliative, Hospice, and End-of-Life Care and OBRA Regulations

Palliative, Hospice, and End-of-Life Care and OBRA Regulations

Home Is Where the Heart Is: The Impact of Home-Based Palliative Care on Patients with Advanced Heart Failure

Introduction There is growing interest in the effect that specialty palliative care (PC) has on outcomes for patients with advanced heart failure (HF). Some evidence suggests that PC may improve quality of life, understanding of prognosis, and documentation of treatment preferences but that it does not affect hospitalization or mortality. Objectives To determine the effect of home-based PC on documentation of treatment preferences and healthcare utilization for patients with advanced HF. Methods A community-based non-profit hospice and PC organization partnered with the heart failure clinic at a general hospital that is a member of a large, state-owned, academic health system. The clinic referred patients with advanced HF to a 30-day program with weekly visits from a PC RN for ongoing physical and symptom assessment, medication reconciliation, advance care planning, home safety evaluation, and psychosocial support. Additional involvement from PC SW, NP, and MD was available as needed. Outcomes included discussion and clarification of code status, discussion and completion of health care power of attorney (HCPOA), and 30-day health care utilization for patients admitted to the program compared to 90 days prior to admission. Results Over 13 months, 40 patients were referred to the program. Of those, 29 agreed to admission, 7 declined admission but enrolled in other services such as hospice, and 4 declined admission and any services. During the 30-day program, code status was discussed with all 29 patients (100%). On admission, code status was “Full” for 23 patients (79%). After 30 days, 11 patients changed their code status to “DNR.” HCPOA completion was discussed with 25 patients (86%). On admission, 15 patients (52%) of patients already had completed a HCPOA. After 30 days, an additional 7 patients completed a HCPOA. On discharge from the program, 17 patients (59%) continued with PC services, 6 (21%) declined follow up, 5 (17%) enrolled in hospice, and 1 (3%) died prior to discharge. Compared to 90 days prior to admission, hospitalizations for the 29 admitted patients decreased 70% from 0.47 hospitalizations per patient per 30 days to 0.14 during the program. Hospitalization length of stay (LOS) decreased 92% from 2.64 days per patient per 30 days to 0.21. Conclusions A 30-day home-based PC program for patients with advanced HF did increase documentation of treatment preferences such as code status and completion of HCPOA. Hospitalizations and hospitalization LOS were reduced during the program when compared to 90 days prior to program admission.

Improving Consumer Assessment of Health Care Providers and Systems Communication Scores in Hospice Care: A Pilot Project.

Although patient satisfaction scores have been used in the inpatient setting for more than a decade, they are new to the hospice and home care setting. Hospice organizations began tracking Consumer Assessment of Healthcare Providers & Systems (CAHPS) scores in 2017, and beginning in 2019, the scores became accessible by the public. The purpose of this quality improvement project was to determine whether improved communication techniques had a positive effect on CAHPS scores at an outpatient nonprofit hospice organization. The intervention was divided into 2 parts, improving communication among staff and improving education provided to patients and their caregivers. This pilot project was implemented over a 4-month period, and the CAHPS scores were compared with those from the 4 months before preceding implementation.