Avoided Hospitalization Criteria: Validating the Impact of a Community-Based Palliative Care Program

Abstract

Objective: This report describes the experiences of a community-based palliative care (CBPC) program's efforts to understand the patterns of hospital utilization, specifically utilization reduction experienced by admitted patients. Efforts to quantify and describe an avoided hospitalization and opportunities to use these data to strengthen partnerships with local insurance payers to assure sustainability of the CBPC will be discussed. Background: Patients with serious chronic illness experience emergency room care and hospitalizations with increasing frequency as their health deteriorates. CBPC programs are well positioned to decrease hospital utilization by early involvement and improved care management. Methods: Arizona Palliative Home Care (AZPHC) program is a free standing CBPC in Maricopa County, Arizona, serving 3300 patients annually. An interdisciplinary team was formed within the CBPC to facilitate the identification of avoided hospital events and communicate these data to community partners in an effective and consistent manner. The processes developed by this team are described. Results: AZPHC has enhanced its hospitalization avoidance strategies by communicating the rate of hospitalization avoidance events in a consistent and strategic manner. Providing instances of avoided hospitalizations with accompanying patient narratives to payers has enabled AZPHC to demonstrate the impact the CBPC has on improving quality of care and reducing overall costs. Discussion: CBPC programs require payment for sustainability; therefore, partnerships with local insurance payers are essential. Presenting data that validate the impact of a program from a clinical and financial perspective will advance the growth of payer-CBPC provider relationships and secure a future for funded CBPC programs.

The 2023-2026 Hospice and Palliative Nurses Association Research Agenda

“…By involving community members, it may be possible to illuminate previously unknown barriers to accessing comfort-focused care. [171][172][173] This is particularly necessary for ensuring the delivery of culturally sensitive equitable care to overcome barriers posed by the social determinants of health of high-need individuals. Secondary data analysis using machine learning and artificial intelligence research methods may uniquely contribute to understanding care transition trajectories and outcomes outside of the hospital setting.…”

“…One way to promote palliative care transitions and avoid nonbeneficial transitions in care is to design community-based participatory research projects. By involving community members, it may be possible to illuminate previously unknown barriers to accessing comfort-focused care 171-173 . This is particularly necessary for ensuring the delivery of culturally sensitive equitable care to overcome barriers posed by the social determinants of health of high-need individuals.…”