Latest Trends and Insights from the National Palliative Care Registry - - PowerPoint PPT Presentation

Latest Trends and Insights from the National Palliative Care Registry™

Maggie Rogers, MPH Director of Research, CAPC Rachael Heitner, MA, CHPCA Research Manager, CAPC

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Latest Trends and Insights from the National Palliative Care Registry™

Maggie Rogers, MPH Director of Research, CAPC Rachael Heitner, MA Research Manager, CAPC

Poll Question

Have you (or your organization) ever submitted data to the National Palliative Care Registry™?

→Yes →No

The National Palliative Care Registry™

→Annual survey on palliative care program’s

• perations, service

delivery, and processes

→Programs participate once a year →No patient-level data or patient-reported outcomes

→Purpose:

→Provide actionable data that programs can use to secure and retain resources →Promote standardization

• f structure and process

→Support the establishment

• f new palliative care

programs

Free and open to all hospital and community programs

2018 Updates

→Focused Scope →Survey Reorganization →Length and Question Changes →One of Many Data Resources

Who Were Our 2018 Inpatient Participants?

2018 Hospital Survey Adult Programs: 425 Participants

86% 7% 7%

Hospital Office Practice or Home Health Agency Hospice

Admin Home

92% are

Not-for-Profit Hospitals

51% are

Teaching Hospitals

21% 29% 50%

Bed Size

< 150 Beds 150-300 Beds > 300 Beds

22% 35% 25% 18%

Region

Northeast South Midwest West

2018 Hospital Survey Pediatric Programs: 54 Participants

100%

Hospital

Admin Home

85% are

Not-for-Profit Hospitals

100% are

Teaching Hospitals

17% 39% 44%

Bed Size

< 150 Beds 150-300 Beds > 300 Beds

15% 37% 24% 24%

Region

Northeast South Midwest West

Patient Encounters

Palliative Care Service Penetration

Palliative care service penetration is the percentage of annual hospital admissions seen by the palliative care team. Penetration is used to determine how well palliative care programs are reaching patients in need.

100 initial consults / 3,500 hospital admissions = 2.9% penetration

Penetration has increased 124% since 2008 (Adult Programs)

2.5 2.7 2.8 3.1 3.5 4.0 4.4 4.8 5.0 5.3 5.6 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Mean Penetration Median Penetration

Differences in Penetration Rates, Adults (2018)

→Bed Size: Hospitals with more than 300 beds see an average of 4.7% compared to 6.4% in hospitals with less than 300 beds →Teaching Status: Teaching hospitals see an average

• f 5.2% compared to 6.0% of programs in non-

teaching hospitals

Differences in Penetration Rates, Adults (2018)

→Consult Triggers: Hospitals with automatic screening criteria see an average of 6.2% compared to 5.1% for hospitals without it in place →Program Maturity: programs who are three years old

• r less see an average of 4.4% compared to 5.7% for

programs who are four years old or older

Patient Encounters, Adults (2018)

Initial Consults 892

• Larger hospitals

provide a larger number of initial consults

• 1,223 for large

hospitals with 300+ beds compared to 358 for small hospitals with <150 beds Follow-Up Visits 1,761

• Larger hospitals

provide a larger number of follow-up visits

• 2,499 for large

hospitals with 300+ beds compared to 474 for small hospitals with <150 beds Visits per Patient 2.8

• 1 initial consult + 1.8

follow-up visits per patient during a single admission

• 3.0 for large hospitals

with 300+ beds compared to 2.4 for small hospitals with <150 beds

Patient Encounters, Pediatrics (2018)

Penetration Rate 3.1%

• Based on the

hospital’s pediatric admissions

Initial Consults 293

• Larger

hospitals provide a larger number of initial consults

Follow-up Visits 1,253

• Larger

hospitals provide a larger number of follow-up visits

Visits per Patient 5.3

• 1 initial

consult + 4.3 follow-up visits per patient during a single admission

Program Staffing

84.2% 82.1% 68.7% 54.4% 39.6% 33.4% 32.2% 30.3% 10.7% 8.6% 7.2% 6.0% 4.3% 3.6% 3.6% 3.3% 3.3% 2.9% 2.1% 1.9% 1.2% 1.2% 0.5% Advanced Practice Registered Nurse Physician Social Worker Chaplain Registered Nurse Administrative Support Program Administrator (Non-Clinician) Medical Director Fellow Pharmacist Physician Assistant Hospice Liaison Music/Art Therapist Child Life Specialist Nutritionist/Dietician Resident Massage Therapist Ethicist Physical/Occupational Therapist Psychologist Licensed Practical/Vocational Nurse Doula Psychiatrist

Core interdisciplinary team disciplines are the most prevalent. 41% of participating

programs report a full, core interdisciplinary team (Physician, APRN or RN, Social Worker, and Chaplain)

Percent of Programs Reporting Specific Staff Disciplines, Adults (2018)

74.1% 96.3% 66.7% 48.1% 61.1% 53.7% 33.3% 33.3% 38.9% 7.4% 5.6% 5.6% 16.7% 29.6% 7.4% 14.8% 7.4% 9.3% 7.4% 22.2% 1.9% 1.9% 1.9% Advanced Practice Registered Nurse Physician Social Worker Chaplain Registered Nurse Administrative Support Program Administrator (Non-Clinician) Medical Director Fellow Pharmacist Physician Assistant Hospice Liaison Music/Art Therapist Child Life Specialist Nutritionist/Dietician Resident Massage Therapist Ethicist Physical/Occupational Therapist Psychologist Licensed Practical/Vocational Nurse Doula Psychiatrist

Pediatric programs have different staffing models than adult programs. 37% of participating

programs report a full, core interdisciplinary team (Physician, APRN or RN, Social Worker, and Chaplain)

Percent of Programs Reporting Specific Staff Disciplines, Pediatrics (2018)

Program Staff FTEs, Adults (2018)

0.3 0.6 1.8 0.8 1.2 2.0 0.3 0.5 0.7 0.5 0.6 1.0 0.2 0.3 0.5 2.1 3.2 6.0

< 150 Beds 150-300 Beds > 300 Beds Physician APRN RN Social Worker Chaplain

FTE: Full-Time Equivalent

APRN FTE have seen the most growth since 2008, with a 150% increase in hospitals with 300+ beds

The largest growth in staff FTEs has been in large hospitals.

FTE: Full-Time Equivalent

2.0 2.0 2.3 3.2 3.1 6.1 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 < 150 Beds 150-299 Beds 300+ Beds

Growth in Staffing FTE in the Interdisciplinary Team, Adults (2018)

Interdisciplinary Team: Physician, APRN, RN, SW, Chaplain

Program Staff FTEs, Pediatrics (2018)

1.4 1.0 0.7 0.7 0.2 4.1

Chaplain Social Worker RN APRN Physician

FTE: Full-Time Equivalent

Over time comparisons are unavailable, as there is not enough historical data

HPM-Certified Clinicians (2018)

Adults →83% had a certified physician →61% had a certified APRN →25% had a certified RN →24% had a certified social worker →8% had a certified chaplain Pediatrics →92% had a certified physician →38% had a certified APRN →24% had a certified RN →7% had a certified social worker →9% had a certified chaplain

Of the programs that reported (at least one) Hospice and Palliative Medicine-certified staff members:

More adequately staffed programs see a larger percentage of annual hospital admissions, Adults (2018)

3.9 4.8 5.5 7.6 < 1.5 FTE per 10,000 Admissions 1.5-2.0 FTE per 10,000 Admissions 2.1-3.0 FTE per 10,000 Admissions > 3.0 FTE per 10,000 Admissions Mean Penetration Median Penetration

Based on: Interdisciplinary Palliative Care Team FTE per 10,000 Hospital Admissions

Billable Provider Workload, Adults (2018)

296 349 523 399 Penetration < 3.0% Penetration 3.0-4.0% Penetration 4.1-6.0% Penetration > 6.0% Billable Provider Workload: Number of Initial Consults per 1 FTE of Physician, APRN, and PA

The number of initial consults completed by billable providers varies by the hospital penetration rate

Program Features

What are the top three reasons for the palliative care consult requests you receive? (2018)

Adults 1. Establishing Goals of Care 91% 2. Pain Symptoms 55% 3. End-of-Life/Hospice Referral 46% 4. Advance Care Planning 42% 5. Family Support and Counseling 18% Pediatrics 1. Establishing Goals of Care 83% 2. Pain Symptoms 43% 3. Family Support and Counseling 43% 4. Advance Care Planning 33% 5. Coordination of Care 32%

Top Referral Sources, Adults (2018)

Referring Locations

46.4% 25.9% 13.1% 7.4% 3.4% Medical/Surgical ICU Step-Down Oncology Emergency Dept

Referring Specialties

50.9% 12.8% 12.8% 7.1% 6.2% Hospitalist Pulm/Critical Care Internal Medicine Family Medicine Oncologist

Less than 1% came from Geriatrics, Gastroenterology, Direct Admission, Hospice, Pediatrics, Maternal Medicine, and Neonatology (each) 3% or less came from Surgeons, Cardiologists, Neurologists, Nephrologists, Gastroenterologists, Maternal Medicine, or Neonatologists

Primary Diagnoses, Adults (2018)

24.1% 12.9% 11.5% 7.7% 6.7% 6.0% Cancer Cardiac Pulmonary Neurologic Complex Chronic Infectious

Dementia, Renal, Gastro, Hepatic, Trauma, Vascular, Endocrine, Hematology, Congenital, Inutero, and Prematurity each account for less than 5 percent of patient diagnoses

Palliative care programs frequently complete consults early during a patient’s admission.

Adults Pediatrics

16.7% 41.2% 33.3% 6.1% 0.2%

Always Often Sometimes Rarely Never

4.0% 48.0% 36.0% 12.0% 0.0%

Always Often Sometimes Rarely Never

Consult Timing: How often are consults completed within 48 hours of admission? (2018)

Palliative care programs strive to respond to consults requests quickly.

Adults Pediatrics

18.8% 65.3% 13.3% 2.4% 0.2%

Always Often Sometimes Rarely Never

10.2% 51.0% 32.7% 6.1% 0.0%

Always Often Sometimes Rarely Never

Consult Timing: How often are consults completed within 24 hours of referral? (2018)

Patient Disposition, Adults (2018)

23.4% 20.8% 17.6% 14.4% 12.3% Home without Hospice Other Health Care Facility Expired Home with Hospice Hospice-Health Care Facility

An additional 7% were either discharged to acute care facility, left AMA, or were not discharged from the hospital during the reporting period

National Guidelines & Recommendations

Adults Pediatrics

National Consensus Project (NCP) Clinical Practice Guidelines for

76.2% 51.9%

Quality Palliative Care The Joint Commission Advanced Certification for Palliative Care

35.8% 20.4%

DNV-GL Healthcare Palliative Care Program Certification

4.5% 3.7%

Does your program follow any national recommendations or guidelines? (2018)

Adherence to NCP Guidelines (2018)

Recommendation Adult Programs Pediatric Programs 24/7 Availability to Patients 46.1% 59.3% Team Wellness Plan 57.1% 69.2% Quality Improvement (QI) Plan 61.2% 44.4% Physician on Team 82.1% 96.3% Social Worker on Team 68.7% 66.7% Chaplain on Team 54.4% 48.1% (At Least One) HPM-Certified Clinician 83.8% 84.9%

Program Funding

What are your Top Three Program Funding Sources? (2018)

Adults

• 1. Hospital/Parent

Organization Financial Support 86%

• 2. Fee-for-Service

Clinician Billing 75%

• 3. Philanthropy 19%

Pediatrics

• 1. Hospital/Parent

Organization Financial Support 85%

• 2. Fee-for-Service

Clinician Billing 65%

• 3. Philanthropy 63%

Website: registry.capc.org Email: registryhelpdesk@capc.org Phone: 212-201-2689

National Palliative Care Registry™

→ The Registry is free and open to all palliative care programs → CAPC Membership is not required to participate

Questions?