Background: New population health community-based models of palliative care can result in more compassionate, affordable, and sustainable high-quality care.Objectives: We evaluated utilization and cost outcomes of a standardized, population health community-based palliative care program provided by nurses and social workers.Design: We conducted a retrospective propensity-adjusted study to quantify cost savings and resource utilization associated with a community-based palliative care program. We analyzed claims data from a Medicare Advantage (MA) plan and used a proprietary predictive model to identify 804 members at high risk for overmedicalized end-of-life care. We enrolled 204 members in the palliative care program and compared them with 600 who received standard, telephonic, health plan case management. We excluded members with fewer than two months of enrolled experience or those with insufficient data for analysis, leaving 176 members in the study group and 570 in the control group for evaluation. We compared differences in utilization and costs (medical and pharmacy), hospital admissions, bed days (acute and intensive care unit [ICU]), and emergency department visits.Setting/Subjects: A 30,000-member MA plan and a health system in Central Ohio between October 2015 and June 2016.Results: Members who received community-based palliative care showed a statistically significant 20% reduction in total medical costs ($619 per enrolled member per month), 38% reduction in ICU admissions, 33% reduction in hospital admissions, and 12% reduction in hospital days.Conclusion: A structured nurse and social work model of community-based palliative care using a predictive model to identify MA candidates for intervention can reduce utilization and medical costs.

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ObjectivesDiscuss the spectrum of usages of the term palliative sedation in clinical practice. Evaluate the scientific evidence regarding the effects and efficacy of palliative sedation to relieve suffering.Discuss the ethical claim that sedation to unconsciousness is inherently questionable. Palliative sedation is widely practiced as a method of last resort to alleviate intractable suffering at the end of life. Recently concerns have arisen over whether the procedure creates suffering or does irreparable harm to the integrity of the dying person. The two goals of this workshop are to (a) consider the different understandings of palliative sedation common in clinical practice and (b) examine the validity of the scientific and ethical objections to palliative sedation. The questions we will address include the following: Can we reliable identify those people for whom palliative sedation may be useful? Is it ever harmful? Can we effectively mitigate that harm, if it exists? We will begin with a summary of the definitions of palliative sedation by professional bodies and a review of how providers in clinical practice operationalize those definitions. Next we will review the scientific claim that we lack the clinical and radiologic tools to determine whether noncommunicative people remain in pain and the ethical claim that sedation to unconsciousness is inherently questionable. Case studies will be used to determine the clinical relevance of these challenges and the difficulties encountered in clinical practice when faced with intractable suffering. By the end of this session, it is anticipated that participants will be able to provide a definition of palliative sedation and discuss some of the more recent ethical and scientific objections to the practice identified in the literature. ObjectivesDefine the need for an effective EMR to improve patient care and meet industry standards.Describe the elements needed for The Joint Commission's accreditation for palliative care. Identify measureable operational, clinical, and financial outcomes. The Joint Commission (TJC) established advanced certification for palliative care programs. The electronic medical record (EMR) provides an opportunity to meet these standards. There are multiple delivery systems that hospital programs use to deliver palliative care. CHE Trinity is the second largest Catholic healthcare system in the country, serving 21 states nationwide, and is standardized using the Cerner EMR system of Powerchart. Palliative care was identified as a system-wide strategic initiative for FY 13-FY 16 . The FY 13 focus was in the acute care setting, and two of three key deliverables were to standardize and centralize documentation and data reporting. It was determined to incorporate both TJC certification standards and NQF palliative care endorsed measurement standards in an effective and user friendly format that meets the need of the palliative care core team. Two workgroups were initiated, documentation and metric, that would support the subsequent delivery system ...