6/7/2017 The Coleman Palliative Medicine Training Program: Summary - - PDF document

6/7/2017 1

The Coleman Palliative Medicine Training Program: Summary of Phase 2 Outcomes

A regional interdisciplinary training program to grow the workforce and expand access to care Sean O’Mahony, MB, BCh, BAO Stacie Levine, MD Tricia Johnson, PhD Aliza Baron, AM

The Coleman Palliative Medicine Training Program: A systematic approach to PC education, program building & expansion

The Need

• Providers lack necessary PC

clinical and program management skills.

• Hospitals do not provide in-

house training.

• National meetings are costly

and insufficient.

• National outcry for an

enlarged, trained, interdisciplinary PC workforce CPMTP Deliverable

• Interdisciplinary, all-levels

learning

• Longitudinal
• Seasoned mentors
• Reality-tested practices
• Enduring relationships
• Regional participation by 23

sites

• Site leadership & administrator

engagement

2 3

• 1. Interdisciplinary training
• 2. Discipline-specific training
• 3. Mentoring
• 4. Shadowing
• 5. Mindfulness-based

resilience training

• 6. PC Program & project

development training

• 7. Leadership engagement

PROVIDER LEVEL Knowledge Skills Network HOSPITAL LEVEL

• 1. Increased health

service utilization

• 2. Process of care

improvements

• 3. Improved care

delivery

• 4. Identifying areas
• f need

PROGRAM EVALUATION HOSPITAL LEVEL

• 1. New PC programs
• 2. Program expansion
• 3. Improvements in PC

quality & access

• 4. PC Scorecards

PUBLIC ACCESS

• 1. Website
• 2. Presentations
• 3. Publications

NEW DESIGN OUTCOME EVALUATION TRAINING PROGRAM ACTIVITIES SHORT TERM OUTCOMES LONG TERM OUTCOMES

The Coleman Palliative Medicine Training Program

6/7/2017 2

Overarching objectives

Report system-level palliative medicine

• utcomes for organizations participating in the

Coleman Palliative Medicine Training Program Products and dissemination Propose an updated program design, incorporating 3600 feedback from administrators, trainees, PC program directors and mentors

4

II. I. III

System-level palliative care outcomes

• 1. Enlarge the PC workforce with trained interdisciplinary

providers

• 2. Increase patient and family access to palliative care

services

• 3. Increase hospice utilization
• 4. Quantify the value of palliative care

5

I.

Expand the trained workforce in PC

6

19 Nurses, 7 Chaplains 5 Social Workers, 4 Physicians 1 Physician Assistant ~ 30 administrators and PC team members attend each conference ~ 85 total per conference

“As a new NP in PC, the program was very supportive and helped me grow…and also helped to facilitate growth at my institution.” 26 Fellows 10 Junior Mentors Doubled guest attendance at conferences Hiring at sites

1 “This program developed our front line team members to see this as part

• f their role...”

6/7/2017 3

29 Core skills for nurses & physicians

7

PAIN

ASSESSMENT & MANAGEMENT

NON PAIN

SYMPTOM MANAGEMENT

MENTAL HEALTH COMMUNICATION

SKILLS

PROGRAM

LEADERSHIP

ETHICAL,

LEGAL ISSUES

PEDIATRICS

Skill Domains

1

Anxiety and depression delirium, spiritual distress Differential diagnosis, pain management with opioids, non-

• pioids, adjuvant analgesics, &

non pharmacologics Nausea/vomiting, dyspnea, symptoms in actively dying patients Support family of dying patients, discuss prognosis, communicate bad news, advance care planning, hospice care, explain PC Teach PC, team leadership, stakeholders ‘ buy-in, leverage resources, PC needs assessment, monitor benchmarks Provide PC, dose opioids, assess pain, assess decisional capacity, give bad news

22 Core skills for PC social workers and chaplains

8

1 27% 27% 18% 14% 4% 5% 5%

Domains

COMMUNICATION DIRECT PRACTICE MENTAL HEALTH TEAM CARE LEADERSHIP/EXPERTISE PALLIATIVE BASICS SPIRITUAL

Program leadership & team-based skills improved significantly in self-ratings, pre and post training

9

Skills Confidence Performance Deliver teaching sessions in PC Lead or communicate effectively on an interdisciplinary team Describe to stakeholders how palliative care can enhance the mission and financial bottom line of an

• rganization

Leverage new and existing resources to build a palliative care program Conduct a needs assessment for PC Monitor performance improvement benchmarks Articulate role & function of chaplain or social worker 1 ALL ALL MED MED ALL ALL MED MED MED MED SW & CH

6/7/2017 4

Significant improvements in leadership, program development and team skills in PC

10

SOCIAL WORKERS & CHAPLAINS

• TEACH PC
• LEAD AN INTERDISCIPLINARY

TEAM

• ARTICULATE ROLE AND

FUNCTION OF SW AND CHAPLAIN

• TEACH PC
• LEAD AN INTERDISCIPLINARY

TEAM

• ARTICULATE ROLE AND

FUNCTION OF SW AND CHAPLAIN

NURSES, PHYSICIANS, PA

• TEACH PC
• LEAD AN INTERDISCIPLINARY

TEAM

• DESCRIBE FINANCIAL BENEFITS

OF PC TO STAKEHOLDERS

• LEVERAGE RESOURCES TO

BUILD A PC PROGRAM

• CONDUCT A PC NEEDS

ASSESSMENT

• MONITOR PERFORMANCE

BENCHMARKS

• TEACH PC
• LEAD AN INTERDISCIPLINARY

TEAM

• DESCRIBE FINANCIAL BENEFITS

OF PC TO STAKEHOLDERS

• LEVERAGE RESOURCES TO

BUILD A PC PROGRAM

• CONDUCT A PC NEEDS

ASSESSMENT

• MONITOR PERFORMANCE

BENCHMARKS

1

Metrics that matter: Extensive outreach & education to administrators

• Multi-pronged: Conference sessions, 1-on-1 site

teleconferences

• Continuous from 2014 - present
• Palliative Care Registry
• Palliative Outcomes Study
• Stated training program requirement
• Carrot = stipend
• Challenges and limitations included
• staff turnover
• mergers, new leadership
• Variability in data tracking
• Access to data

11

1

Palliative medicine team size increased or remained stable over time for all but 1 community hospital

1 2 3 4 5 6 7 8 2012 2014 2015 2016 FTEs

Hospital 8 Hospital 20 Hospital 10 Hospital 21 Hospital 18 Hospital 25 Hospital 2 Hospital 11

1

6/7/2017 5

5 10 15 20 2012 2014 2015 2016 FTEs

Hospital 24 Hospital 22 Hospital 3 Hospital 27 Hospital 6 Hospital 9 Hospital 4 Hospital 5 Hospital 1 Hospital 14

Palliative medicine team size increased or remained stable over time for all but 1 teaching hospital

1

In aggregate, the number of trained palliative medicine clinicians increased substantially

14 51 94 98

2012 2014 2015

1

15.65 26.37 27.11 30.39

2012 2014 2015 2016

For the 19 organizations reporting staffing data for 2012 to 2015: +12% +94% For the 6 organizations reporting 2012 – 2016 staffing data: +92%

2 4 6 8 10 12 FTEs

Chaplain SW Nurse APN Physician

Palliative medicine team teams were highly interprofessional (2015)

1

6/7/2017 6

Programs grew substantially during the fellowship program

• 50%

0% 50% 100% 150% 200% 250% 300% 350%

Overall FTE Growth During the Coleman Program 1

• 20%

0% 20% 40% 60% 80% 100% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

17

Programs grew substantially during the fellowship program

1

Annualized FTE Growth During the Coleman Fellowship Program

7 programs met the CAPC guidelines for an interdisciplinary palliative care team

1 2 3 4 5 6 7 8 9 10

Hospital 5 Hospital 9 Hospital 7 Hospital 25 Hospital 6 Hospital 10 Hospital 23 Chaplain SW Nurse APN Physician

Of the programs that didn’t meet team criteria, 31% were missing a physician, 13% missing an APRN or RN, 63% missing a SW, and 88% missing a chaplain. 1

6/7/2017 7

INCREASE PATIENT AND FAMILY ACCESS TO PALLIATIVE CARE SERVICES

Practice Improvement Projects Growth in Staffing Growth Patient Volume

19

Practice improvement projects aimed to improve quality and access to palliative care

20

CONFERENCE EDUCATION –

QUALITY STANDARDS, METRICS THAT MATTER, INTENT TO CHANGE CONTRACTS

INTERDISCIPLINARY

GROUP CONSULTATION

DISCIPLINE-SPECIFIC

PROJECT CONSULTATION

ONE-ON-ONE

MENTORING

2 Multi-modal training prepared trainees to create and implement effective projects

Regional reach of the training program

29 SITES TOTAL 14 - CONTINUOUS

PARTICIPATION

2013 – 2017 PHASE 1 20 SITES 2013 - 2015 PHASE 2 22 SITES 2015 – 2017 (8 NEW)

21

2

6/7/2017 8

23 participating sites and 36 interdisciplinary PC champions

22

10 9 2 2 16 12 4 4 2 4 6 8 10 12 14 16 18 TEACHING HOSPITALS COMMUNITY HOSPITALS OUTPATIENT CLINICS SAFETY NET HOSPITALS

Participating Sites Fellows & Jr. Mentors

2

30 Projects implemented at 35 practice settings

23

17 14 1 2 1 INPATIENT OUTPATIENT HOME PC NURSING

HOME

HOME

HOSPICE

2 4 6 8 10 12 14 16 18 PROJECT REQUIREMENTS:  MEETS A NEED  INSTITUTIONAL SUPPORT  MEASURABLE OUTCOMES  2-YR. TIMELINE  COMPATIBLE WITH JOB

RESPONSIBILITIES

2

Multiple, diverse project outcomes

24

INCREASED PATIENT

ACCESS TO CARE

13 PROJECTS

IDENTIFYING

AREAS OF NEED

13 PROJECTS CARE DELIVERY

IMPROVEMENTS

11 PROJECTS PROCESS OF

CARE IMPROVEMENTS

8 PROJECTS IMPROVED

HEALTH SERVICE UTILIZATION

3 PROJECTS

2

6/7/2017 9

Growth of palliative medicine visits

25

And the number of palliative care visits also increased at an even faster rate

Based on organizations that reported data in all years.

16,756 32,927 40,117

2012 2014 2015

139% increase in visits

Resulting in an increase in visits per palliative care team FTE

3,196 3,299 3,615

2012 2014 2015

+419 visits per FTE

2 For the 4 organizations reporting visit data for both 2015 and 2016, visits increased by 24% and visits per FTE increased by 23%

Inpatient and outpatient palliative care visits increased substantially over time

26

5000 10000 15000 20000 25000

New inpatient visits Return inpatient visits New

• utpatient

visits Return

• utpatient

visits 2012 2014 2015

Based on organizations that reported Registry data in all 3 years.

2

5000 10000 15000 20000 25000

New inpatient visits Return inpatient visits New

• utpatient

visits Return

• utpatient

visits 2015 2016

Palliative Care Visits by Primary Diagnosis

0% 20% 40% 60% 80% 100% 120%

Hospital 11 Hospital 4 Hospital 9 Hospital 17 Hospital 1 Hospital 5 Hospital 10 Hospital 25 Hospital 23 Hospital 14 Hospital 3 Hospital 18 Hospital 16 Dementia Neurological Illness Pulmonary Disease Heart Disease Cancer

As a comparison the 2014 NHPCO percentage of hospice admissions by primary diagnosis were 37% Cancer, 15% Dementia, 15% Heart Disease, and 9% Lung Disease

34

Slide 27 34 What are the conditions for those with low cancer proportions Delete Kish Health

Tricia Johnson, 5/26/2017

6/7/2017 10

HOSPICE UTILIZATION

28

3

The proportion of end-of-life patients discharged to hospice has increased since 2012

Non- Teaching Teaching All Hospitals 40% 45% 50% 55% 60% 2012 (Jul- Dec) 2013 2014 2015 (Jan- Jun)

29 Based on the 18 programs that reported 2015 Registry data.

22,031 discharges to hospice avoided an estimated $37.5M in hospital costs across these 18 programs

3

Non- Teaching Teaching All Hospitals 40% 45% 50% 55% 60% 2012 (Jul- Dec) 2013 2014 2015 2016 (Jan- Jun) 35

Differences in the types of patients with a palliative care consultation in their final hospital stay exist (2012-2014)

10 20 30 40 50 60 10 20 30 40

Commercial Medicare Medicaid/Self-Pay

20 40 60

Site 8 Site 9 Site 11

3 Hospital Sample 3 Proportion of patients receiving a palliative care consultation by condition, primary insurance and site

*3.4 times more likely receive PC consultation if diagnosis was neoplasm *1.5 times more likely to receive PC consultation if insurance other than Medicaid *6.0 times more likely to receive PC consultation depending on site

Slide 29 35 Erik, this information should come from the "all hospitals" percentages that we included in the scorecard

Tricia Johnson, 5/28/2017

6/7/2017 11

Differences in the types of patients discharged to hospice in their final hospital stay exist (2012-2014)

50 100 Consult No Consult

Hospice

50 Female Male

Hospice

Hospice 10 20 30 40 50 60 70

Hospice

Hospice 3 Hospital Sample

*4.98 times more likely to be discharged to hospice vs hospital if receive a consult *1.37 times more likely to be discharged to hospice if female *3.66 times more likely to be discharged to hospice vs hospital if diagnosis neoplasm

Proportion of patients discharged to hospice by condition, consultation, and gender

QUANTIFYING THE VALUE

32

4

Quantifying the value of palliative medicine provided 2012-2015

33 Notes: Reimbursement is based on the Medicare physician fee schedule for 2016; only sites that provided data for all 3 years were included in this analysis (N=8); 2012 Registry did not collect information on outpatient return visits. $1,568,203 $3,226,022 $3,908,181

2012 2014 2015

Palliative care consultations reduce hospital costs by

$1700 per patient

discharged to hospice

$5000 per in-hospital death

At least $16,349,000 in hospital costs were avoided in 2015, assuming the 9,617 new palliative care consultations resulted in discharge to hospice 4

6/7/2017 12

Quantifying the value of palliative medicine provided 2015-2016

34 Notes: Reimbursement is based on the Medicare physician fee schedule for 2017; only sites that provided data for both years were included in this analysis (N=4); One site did not provide 2015 information on inpatient return visits. $1,263,825 $1,590,402

2015 2016

Palliative care consultations reduce hospital costs by

$1700 per patient

discharged to hospice

$5000 per in-hospital death

At least $7,344,000 in hospital costs were avoided in 2016, assuming the 4,320 new palliative care consultations resulted in discharge to hospice 4

COLLECTING AND UTILIZING METRICS THAT MATTER

35

5

Benchmarking Performance

• How does your program staffing compare to other

programs?

• How do the services provided by your organization

compare to other programs?

• How can we measure palliative medicine program

productivity?

36

5

6/7/2017 13

Scorecard assumptions

• Programs reporting registry data for 2015
• For “All Hospital” and “Teaching/Community Hospital” comparisons,

programs needed to report new and return visits to be included

• Comparison data points only reported if 5 or more responses

available

• Visits per FTE were based on billing provider full-time equivalents
• nly (physicians and advanced practice providers)
• Hospice use and length of hospital stay for hospice/in-hospital deaths

based on COMPData for July 2012 – June 2015

• Scorecards are preliminary – will be updated if more data become

available

37

5

Challenges

Satisfaction data for end-of-life patients not collected

• Other patients with palliative care consultations represent an extremely small

proportion of patients surveyed, and many hospitals cannot identify these patients

• Programs collecting satisfaction information could share best practices with
• thers

38

1

Detailed information on patients with palliative care consultations only available for a small number of programs

• This is an important source of information for understanding who is receiving

palliative care and the downstream impact 2

Incomplete information for many programs

• Many programs reported that data were not collected at that time
• Opportunity for sharing best practices going forward

3

PRODUCTS & DISSEMINATION PHASE 2: 2015 - 2017

Palliative Medicine Scorecards Publications Presentations

39

II.

6/7/2017 14

Palliative Medicine Program Scorecard

Summary Scorecard 01 March 2017 Palliative Care Program Scorecard

Program Overview All Community Hospitals Median (25th, 75th) All Teaching Hospitals Median (25th-75th) All Programs Median (25th-75th) Number 10 10 21 Total Beds 310 (159 – 425) 502 (312 – 638) 390 (172 – 510) Program FTEs 3.2 (2.6 – 5.0) 3.3 (1 -10.3) 3.2 (2.6 – 7.0) Physicians 0.4 (0 – 1.0) 1 (0 – 3.5) 1 (0 – 1.8) Nurses 0 (0 – 1.0) 0.7 (0 – 1.6) 0 (0 – 1) Advance practice providers 1.5 (1.0 – 2.0) 1 (0 – 2) 1.5 (1 – 2) Social workers 0.5 (0 – 0.6) 0.5 (0 – 1) 0.5 (0 – 1) Chaplains 0 (0 – 0.5) 0 (0 – 0.5) 0 (0 – 0.5) Other staff 0 (0 – 0.5) 0.1 (0 – 0.5) 0 (0 – 0.5) Palliative care services offered Inpatient services 90% 90% 90% Home-based services 50% 20% 38% Outpatient clinic 40% 70% 52% Skilled nursing facility services 30% 20% 29% Count of palliative care services offered 60% offer two services 50% offer two services 52% offer two services 41

All Programs Palliative Care Program Scorecard

Visit Summary All Community Hospitals Median (25th-75th) All Teaching Hospitals Median (25th-75th) All Programs Median (25th-75th) Total visits (inpatient, home, outpatient clinic, skilled nursing facility) 1,216 (300 – 2,700) 5,801 (514 – 9,777) 1,471 (363 – 6,800) New visits 287 (219 – 607) 1,630 (463 – 1,800) 463 (240 – 1,762) Return visits 940 (60 – 2,093) 4,153 (51 – 8,015) 1,252 (51 – 4,700) Inpatient visits1 1,932 (473 – 2,314) 4,715 (486 – 8,265) 2,314 (473 – 5,900) New visits 489 (240 – 1,157) 1,322 (442 – 1,570) 1,157 (351 – 1,500) Return visits 1,157 (264 – 1,443) 3,394 (44 – 6,695) 1,443 (60 – 4,500) Home-based visits ** ** 467 (58 – 700) Outpatient clinic visits1 ** 763 (157- 1,250) 768 (488 – 1,200) New visits ** 171 (52 – 254) 149 (118 – 200) Return visits ** 561 (105 – 850) 650 (364 – 850) Skilled nursing facility visits ** ** ** 42

All Programs

1 Median inpatient and outpatient clinic visits for “All Program” and “All Teaching Program” comparison groups are limited to programs

reporting both new and return visits. ** Fewer than 5 responses

6/7/2017 15

Palliative Care Program Scorecard

All Community Hospitals Median (25th-75th) All Teaching Hospitals Median (25th-75th) All Programs Median (25th-75th) Visits per hospital 100 hospital beds Total visits 466 (126 – 692) 831 (116 – 1,528) 648 (126 – 831) Inpatient visits1 459 (297 – 495) 673 (116 – 1,291) 495 (136 – 738) Home-based visits ** ** ** Outpatient clinic visits1 ** 125 (31 – 159) 156 (95 – 197) Skilled nursing facility visits ** ** ** Visits per palliative care team FTEs Total visits 400 (300 – 675) 1,328 (1,2347 – 1,521) 578 (213 – 1,283) Inpatient visits1 483 (300 – 643) 1,123 (981 – 1,255) 812 (300 – 1,255) Home-based visits ** ** 79 (29 – 100) Outpatient clinic visits1 ** 154 (79 – 256) 192 (102 – 244) Skilled nursing facility visits ** ** ** 43

All Programs

1 Median inpatient and outpatient clinic visits for “All Program” and “All Teaching Program” comparison groups are limited to programs

reporting both new and return visits. ** Fewer than 5 responses

Palliative Care Program Scorecard

44

All Programs

0% 10% 20% 30% 40% 50% 60% 2012 2013 2014 2015

Proportion of Discharges to Hospice versus In-Hospital Death

All Community All Teaching Hospitals All Hospitals 2 4 6 8 10 2012 2013 2014 2015

Length of Hospital Stay Patients Discharged to Hospice

2 4 6 8 10 2012 2013 2014 2015

Patients Expiring In-Hospital

All Community All Teaching Hospitals All Hospitals

Publications

1.

O’Mahony S, Levine S, Baron A, Johnson TJ, Ansari A, Leyva I, Marschke M, Szmuilowicz E, Deamant C. (In press). Palliative workforce development and a regional training program. American Journal of Hospice and Palliative Medicine.

2.

Levine S, O’Mahony S, Baron A, Ansari A et al. Training the workforce: Description of a longitudinal interdisciplinary education and mentoring program in palliative care. Journal of Pain and Symptom Management. 2017 Apr;53(4):728-737.

3.

O’Mahony, S., Ziadni, M., Hoerger, M., Levine, S., Baron, A., Gerhart, J. (In press). Compassion fatigue among palliative care clinicians: Findings on personality factors and years of service. American Journal of Hospice and Palliative Medicine.

4.

Jeuland J, Fitchett G, Schulman-Green D, Kapo J. Chaplains working in palliative care: Who they are and what they do. Journal of Palliative Medicine. 2017: 20(5):502-08.

5.

Nelson-Becker, H. Spirituality, Religion, and Aging: Illuminations for Therapeutic

• Practice. Thousand Oaks, CA: Sage Publications: 2017.

6.

O’Mahony S, Gerhart J, Levy M, Grosse J, Abrams A. Posttraumatic Stress Disorder Symptoms in Providers: Prevalence and Vulnerability through Avoidant and Inflexible

• Coping. Palliative Medicine Journal Epub ahead of Print July 17, 2015 PMID:

26186929

7.

Gerhart J, O’Mahony S, Greene M, Abrams I, Levy M. JCBS-D-15-00055R4. A Pilot Test of a Mindfulness-Based Communication Training to Enhance Resilience in Palliative Care Professionals Journal of Contextual Behavioral Science. April 18 2016 DOI: 10.1016/j.jcbs.2016.04.003

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6/7/2017 16

Presentations 2015 - 2017

INTERNATIONAL

• Society for Clinical and Experimental Hypnosis conference Key Note Address. Work Force Resiliency and the

role of mindfulness training for palliative medicine clinicians November 2017

• 27th Surgical Nursing and Nursing Education Conference Key Note Address. Primary Palliative Care Education

Program Abu Dubai United Arabic Emirates October 2017 NATIONAL

• American Academy of Hospice and Palliative Medicine (AAHPM) 2017: “The Dreaded Dialysis Discussion:

What the Evidence Shows and How to Effectively Facilitate the Conversation”

• National Association of Catholic Chaplains’ 2017 Conference Workshop: “Spiritual Assessment in Palliative and

End of Life Care”

• Center to Advance Palliative Care (CAPC) Multi-Payer Workgroup Meeting, Oct 2016: “Coleman Fellowship

Program - Sustaining the Workforce Through Team Engagement: A Regional Training and Mentoring Program for Interdisciplinary Palliative Medicine Providers”

• American Academy of Hospice and Palliative Medicine (AAHPM) 2016. “Sustaining the Workforce Through

Team Engagement: A Regional Training and Mentoring Program for Interdisciplinary Palliative Medicine Providers”

• Social Work Hospice and Palliative Care Network General Assembly, March 2016. “Keeping Social Workers in

Palliative Care: The Interdisciplinary Coleman Palliative Medicine Training Project”

• Gerontological Society of America (GSA) November 2016. “Inter-professional Training in Palliative Care: A

Regional Model to Competency”

• Gerontological Society of America (GSA) November 2015. Symposium: “Inter-professional Palliative Medicine

Training: A Social Work and Chaplaincy Framework”

• Center to Advance Palliative Care (CAPC), Nov. 2015. “Addressing the Workforce Shortage: A Regional

Training Program in Palliative Medicine for Interdisciplinary Providers” REGIONAL

• Family Medicine Midwest Oct 2016. Preconference workshop: “A Multi-Disciplinary Team Approach to Managing

Pain in Chronic Illness”

46

NEW PROGRAM PROPOSAL - FROM 3600 FEEDBACK

3600 feedback is feedback received from trainees, administrators, program directors, and faculty mentors

47

III.

3600 Feedback informs new program components

48

NURSE

PRACTITIONER TRAINING, REDUCE STAFF TURNOVER, PEER NETWORK

PROGRAM DIRECTORS TRAINEES & MENTORS REALITY-TESTED EDUCATION,

MENTORING, CERTIFICATION, CROSS-DISCIPLINARY SHADOWING, PROFESSIONAL NETWORK

TRAINING PROGRAM DIRECTORS REDUCE OPERATIONAL COSTS,

INCREASE SITE PENETRATION, METRICS UTILITY, OBTAIN CUSTOMER OUTCOMES, STANDARDIZED OUTCOMES

ADMINISTRATORS EXPAND PC

PROGRAMS - OUTPATIENT & EMBEDDED CLINICS, METRICS TRAINING

NEW HIGHLIGHTS COST BRIDGING , APN

IMMERSION, CERTIFICATION SUPPORT, METRICS CONSULTATIONS, INSTITUTIONAL PC GOALS & COMMITMENTS

6/7/2017 17

Keys to sustainment and impact

49

Diversify & enlarge site teams: Open access, Admin & tech specialists’ track Reduce program costs & combine funding: Webinar & teleconference education, Sites cover trainees’ time Market needed services: APN Training, Program growth consultations Uniform, cross-site project teams: Shared goals & tools, Quarterly meetings, Mentors present Real-time quality and operational improvements: Bi-annual reporting, Include patient & family outcomes, Scorecard distribution,

SUPPLEMENT

Program Information & Outcomes: Phase 2

50

Trainees’ leadership roles and certification goals

• New leadership roles
• Regional director of palliative care
• Director of palliative care
• Director of quality
• Director of home health services, covering inpatient, outpatient,

community-based, hospice and private duty

• Member of the population health advanced practice team
• 4 delivered webinars or presentations on PC to national or

regional audiences

• 17% (6) earned PC certification
• 63% (19) consider pursing PC certification

1

6/7/2017 18

70% of skills increased significantly in confidence by nurse and physician self-report, pre to post

9 8 4 3 1 2 3 4 5 6 7 8 9 10 LOW PRE,

SIGNIFICANT CHANGE POST

MODERATE/HIGH

PRE, SIGNIFICANT CHANGE POST

MODERATE/HIGH

PRE, NO SIGNIFICANT CHANGE

LOW PRE, NO

SIGNIFICANT CHANGE

Skills

24 Skills, 13 trainees

52

1 “I have high confidence in conducting challenging family meetings… My listening skills have improved. I learned about how to do the symptom management.”

Nurses & physicians self-report more frequently performing 41% of skills, pre to post training

7 2 5 8 1 2 3 4 5 6 7 8 9 LOW PRE,

SIGNIFICANT CHANGE POST

MODERATE/HIGH

PRE, SIGNIFICANT CHANGE POST

MODERATE/HIGH

PRE, NO SIGNIFICANT CHANGE

LOW PRE, NO

SIGNIFICANT CHANGE

Skills

22 Skills*, 13 trainees

53

1 *Managing ethical and legal issues in PC are not included in this analysis.

55% of skills increased significantly in confidence by chaplain and social workers’ self-report, pre to post

54

3 9 6 4 1 2 3 4 5 6 7 8 9 10 LOW PRE,

SIGNIFICANT CHANGE POST

MODERATE/HIGH

PRE, SIGNIFICANT CHANGE POST

MODERATE/HIGH

PRE, NO SIGNIFICANT CHANGE

LOW PRE, NO

SIGNIFICANT CHANGE

Skills

22 Skills, 13 trainees

1

6/7/2017 19

55

Increased Access to Care

•  CONSULTS
•  INPATIENT

VISITS

•  OUTPATIENT

VISITS

•  SPIRITUAL

CARE ASSESSMENTS

•  PC VISITS IN

NURSING HOME

Identifying areas for improvement

• COMMUNICATION

ACROSS SETTINGS

• FAMILY

EDUCATION & COMMUNICATION

• STAFF

EDUCATION, PERCEPTION OF

PC

• UNMET

SPIRITUAL CARE NEEDS

Care delivery improvements

•  SYMPTOM

MANAGEMENT

•  ADVANCE

DIRECTIVES COMPLETED

•  POLST

COMPLETION

•  PATIENT

PALLIATIVE PERFORMANCE SCORES

Real-life results of practice improvement projects

2

56

Process of care improvements

• NEW DOCUMENTATION
• COLLECTION OF

DASHBOARD METRICS

Improved health service utilization

•  RE-

HOSPITALIZATION

•  HOSPICE USE

Real-life results of practice improvement projects

2

Systems-based takeaways

57

Metrics and performance improvements go hand-in-hand. Metrics provide stability through knowledge management. Administrators & program directors need guidance identifying metrics that matter. PC program directors identify staff training & retention as top need (2016). Administrators cite “expanding PC” as #1 ongoing need (3/2017). No other PC training program offers the scope of education, program management, mentorship, and a regional network.

6/7/2017 20

58

“…brought colleagues together who are bright, gifted leaders in

• ur field, and gave us meaningful information, guidance,

mentoring, encouragement and powerful thought leadership…We "spun off" projects, research as well as friendships and a strong desire to continue meaningful work together to advance our profession and palliative medicine.”