Pro-active Palliative Care for Hospitalized Primary Care Patients |
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| Institution: | 1. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;2. Johns Hopkins Hospital, Johns Hopkins Medical School, Baltimore, Maryland, USA;3. Massachusetts General Hospital, Boston, Massachusetts, USA;4. Tufts Medical Center, Tufts Medical School, Boston, Massachusetts, USA;1. Brookdale Department of Geriatrics and Palliative Medicine (J.L.F., L.P.G., C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA;2. Section of Palliative Care and Medical Ethics (R.M.A.), University of Pittsburgh, Pittsburgh, Pennsylvania, USAS;3. Geriatric Research (L.P.G.), Education & Clinical Center, James J. Peters Veterans’ Affairs Medical Center, Bronx, New York, USA;4. Division of Hematology and Medical Oncology (C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA;1. Department of Integrated Traditional Chinese and Western Medicine (L.Z., N.L.), West China Hospital, Sichuan University, Chengdu, Sichuan, China;2. Sichuan Second Chinese Medicine Hospital (Y.L., D.X., Y.D.), Chengdu, Sichuan, China;3. Chengdu University of Traditional Chinese Medicine (X.X., Y.S.), Chengdu, Sichuan, China;1. VHA National Center for Ethics in Health Care (M.S.W., C.M.A.G.), Washington, District of Columbia, USA;2. Department of Pediatrics (M.S.W.), University of Nebraska Medical Center, Omaha, Nebraska, USA;3. Departments of Psychiatry and Internal Medicine (C.M.A.G.), Ethics Education, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA;1. Baylor University Medical Center (A.J., G.T.), Division of Abdominal Transplantation, Dallas, Texas;2. Baylor University Medical Center (H.P.), Department of Internal Medicine, Dallas, Texas;3. Baylor University Medical Center (N.B.), Division of Trauma and Acute Care Surgery, Dallas, Texas;4. Baylor University Medical Center (M.C., R.F.), Supportive Palliative Care, Dallas, Texas;5. Southwest Transplant Alliance (C.T., B.L.A., P.N.), Dallas, Texas |
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| Abstract: | BackgroundEarly integration of palliative care (PC) improves outcomes for patients with cancer and heart failure. Data on the role of PC in complex general medicine patients is scant.MeasuresWe identified high-mortality risk patients from our primary care practice by screening with mortality indices upon hospital admission. We measured documentation of advanced care planning (ACP), including health care proxy (HCP) and goals of care (GOC), at admission and discharge.InterventionWe offered pro-active PC consultation to attending physicians of patients with high mortality risk. Patients who received pro-PC consultation were compared to patients whose attending physicians declined consultation (pro-PC declined) as well as patients who received usual care (UC).OutcomesCompared to UC and pro-PC declined groups, the pro-active PC group demonstrated increased rates of HCP and GOC documentation.ConclusionsOur initiative identified hospitalized primary care patients with high-mortality risk, improved gaps in ACP, and was feasible to implement. |
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