PCQN Data Steven Pantilat, MD David ORiordan , PhD Ashley Bragg - PowerPoint PPT Presentation

PCQN Data Steven Pantilat, MD David O’Riordan , PhD Ashley Bragg November 21, 2013

PCQN Database • Operational since June 2013 • 4 sites currently submitting data • Over 1400 consults • Standardized reports by site and for entire PCQN

PCQN Patient Characteristics Characteristics Number of patients analyzed 1386 (4 hospitals) Age (Years) Mean= 69, Range: 20 - 104 Gender (Female) 50% LOS Pre referral (Days) Mean= 7, Range: 1 - 129 LOS during consult (Days) Mean= 6, Range: 1 - 162 Days Symptoms assessed Mean= 2.6

Length of Stay 25 3 Days* 4 Days* 2 Days* 2 Days* 20 10 15 Days 6 10 4 11 5 5 8 6 3 0 Hospital 1 Hospital 2 Hospital 3 Hospital 4 Prior to consult During Consult *: Days symptoms were assessed during consultation

Location at Time of Referral Unknown 2 Other 0.2 Ambulatory/Outpt. 0.1 Emergency Dept. 5 Telemetry/Stepdown 27 Critical Care 26 Medical/Surgical 40 0 10 20 30 40 50 Frequency (%)

Referral From Med/Surg and Critical Care 60 48 50 40 Frequency (%) 37 40 30 30 25 25 23 22 20 10 0 Hospital 1 Hospital 2 Hospital 3 Hospital 4 Medical/Surgical Critical Care

Reason for Consultation No reason given 1 Other 8 Withdraw interventions 3 Comfort care 5 Transfer to comfort care bed 12 Hospice referral 14 Symnptom management 17 Pain management 21 Goals of care 69 0 10 20 30 40 50 60 70 80 Frequency (%)

Consultation for Pain Management 35 29 30 25 23 22 Frequency (%) 20 15 10 7 5 0 Hospital 1 Hospital 2 Hospital 3 Hospital 4

Primary Diagnosis Vascular 1 Unknown 1 Other 1 Trauma 2 Immune Defficiencies 2 Gastro. 2 Dementia 3 Hepatic 4 Renal 4 Failure to thrive 4 Pulmonary 10 Neuro/stroke 11 Cardiac 12 Cancer 43 0 10 20 30 40 50 Frequency (%)

Primary Diagnosis: Cancer 70 59 60 50 Frequency (%) 43 40 35 30 19 20 10 0 Hospital 1 Hospital 2 Hospital 3 Hospital 4

Improved Symptom Scores 1 st – > Last day Anxiety 42 Day 1 > 0 Dyspnea 47 Pain 47 Nausea 53 0 20 40 60 80 100 Frequency (%)

Improved Pain Score by Hospital 100 1 st – > Last day Day 1 > 0 80 71 Frequency (%) 60 48 42 40 40 20 0 Hospital 1 (n=84) Hospital 2 (n=14) Hospital 3 (n=19) Hospital 4 (n=5)

Disciplines in Consultation Clin. Nurse Specialist 12 Registered Nurse 19 Chaplain 39 Social Worker 43 Physician 65 0 20 40 60 80 100 Frequency (%)

Number of Family Meetings 60 A family meeting can be scheduled or spontaneous and includes key member(s) 48 of the PC team, key member(s) of the patient’s family, and addresses a wide Frequency (%) 40 range of issues (e.g. more than just symptoms or just disposition) 20 18 20 7 4 1 1 0 0 1 2 3 4 5 >5 Number of family meetings

Family Meetings by Hospital 80 66 60 55 Frequency (%) 41 41 40 35 22 21 21 19 20 16 12 9 8 8 7 7 5 4 4 2 0 0 1 2 3 4+ Number of family meetings Hospital 1 Hospital 2 Hospital 3 Hospital 4

Palliative Performance Scale 30 21 20 Frequency (%) 16 14 13 10 10 6 2 1 1 0.4 0.3 0 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Code Status Unknown 2 DNR/DNI 44 Partial 8 Full 46 0 20 40 60 80 100 Frequency (%)

Code Status by Hospital 100 80 Frequency (%) 57 60 48 48 47 44 42 40 38 40 20 15 9 6 3 3 1 0 0 0 Full Partial DNR/DNI Unknown Code Status Hospital 1 Hospital 2 Hospital 3 Hospital 4

Discharge Disposition 50 43 40 37 36 34 34 Frequency (%) 31 30 29 30 28 28 20 18 18 17 13 10 7 0 Hospital 1 Hospital 2 Hospital 3 Hospital 4 Mean Home Home with Hospice Died

PCQN Data • Variation across sites • Process and outcome measures • Data provides ranges and targets – Deeper dive to understand variation

PCQN Data • What stands out? • What strikes you about the data? • How would you use the data? • Who would you want to share it with? • What questions do the data raise?