The Palliative Care Quality Network: Improving the Quality of Caring

Pantilat, Steven Z.; Marks, Angela; Bischoff, Kara; Bragg, Ashley

doi:10.1089/jpm.2016.0514

Cited by 36 publications

(28 citation statements)

References 9 publications

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“…12 As of December 31, 2016, there were 78 PC teams entering patient-level data into the PCQN database from a diverse group of academic and community hospitals in eleven states in the United States.…”

Section: Methodsmentioning

confidence: 99%

Care Planning for Inpatients Referred for Palliative Care Consultation

et al. 2018

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IMPORTANCE Care planning is a critical function of palliative care teams, but the impact of advance care planning and goals of care discussions by palliative care teams has not been well characterized.OBJECTIVE To describe the population of patients referred to inpatient palliative care consultation teams for care planning, the needs identified by palliative care clinicians, the care planning activities that occur, and the results of these activities. DESIGN, SETTING, AND PARTICIPANTSThis was a prospective cohort study conducted between January 1, 2013, and December 31, 2016. Seventy-eight inpatient palliative care teams from diverse US hospitals in the Palliative Care Quality Network, a national quality improvement collaborative. Standardized data were submitted for 73 145 patients. EXPOSURES Inpatient palliative care consultation.RESULTS Overall, 52 571 of 73 145 patients (71.9%) referred to inpatient palliative care were referred for care planning (range among teams, 27.5%-99.4% of patients). Patients referred for care planning were older (73.3 vs 67.9 years; F statistic, 1546.0; P<.001), less likely to have cancer (30.0% vs 41.1%; P < .001), and slightly more often had a clinical order of full code at the time of referral (54.6% vs 52.1%; P < .001). Palliative care teams identified care planning needs in 52 825 of 73 145 patients (72.2%) overall, including 42 467 of 49 713 patients (85.4%) referred for care planning and in 10 054 of 17 475 patients (57.5%) referred for other reasons. Through care planning conversations, surrogates were identified for 10 571 of 11 149 patients (94.8%) and 9026 patients (37.4%) elected to change their code status. Substantially more patients indicated that a status of do not resuscitate/do not intubate was consistent with their goals (7006 [32.1%] preconsultation to 13 773 [63.1%] postconsultation). However, an advance directive was completed for just 2160 of 67 955 patients (3.2%) and a Physicians Orders for Life-Sustaining Treatment form was completed for 8359 of 67 955 patients (12.3%) seen by palliative care teams.CONCLUSIONS AND RELEVANCE Care planning was the most common reason for inpatient palliative care consultation, and care planning needs were often found even when the consultation was for other reasons. Surrogates were consistently identified, and patients' preferences regarding life-sustaining treatments were frequently updated. However, a minority of patients completed legal forms to document their care preferences, highlighting an area in need of improvement.

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Section: Methodsmentioning

confidence: 99%

Care Planning for Inpatients Referred for Palliative Care Consultation

et al. 2018

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“…Future steps include an independent review of PC consult documentation to evaluate the services provided using Palliative Care Quality Network metrics. 26 The study team also plans to compare this intervention with a validated screening tool to determine which is more efficient at identifying patients requiring PC consultation. Assessing the durability of the findings after the completion of the study is another important direction for future study.…”

Section: Discussionmentioning

confidence: 99%

Interprofessional Rounds Improve Timing of Appropriate Palliative Care Consultation on a Hospitalist Service

et al. 2018

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Despite known benefits, palliative care (PC) consultation for hospitalized patients remains underutilized. The objective was to improve frequency and timeliness of appropriate inpatient PC consultation. On 2 of 11 hospitalist teams, a PC representative attended discharge rounds twice a week. Control teams' discharge rounds were unenhanced. Subjects were all patients admitted to a hospitalist service in a quaternary academic medical center. The primary outcome was change in provision of PC consultation over time; the secondary outcome was change in time-to-consult (days). Hospitalists were surveyed regarding the intervention. The unadjusted proportion of patients receiving PC consultation increased from 2.7% to 5.2% on the intervention teams. Compared to control teams over time and adjusting for multiple covariates, the intervention increased PC consultation (difference-in-difference [DID] = 1.0 percentage-point increase [95% CI = 0.3%-1.8%]) and decreased time to consult (DID = -5 days [95% CI = -11 to -1]) in patients admitted for noncancer diagnoses. Hospitalists thought the intervention facilitated effective patient care without increased burden.

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“…The PCQN is a national collaborative of specialty PC teams in hospitals and health care organizations across the United States that collect standardized data on processes of care and patient-level outcomes. 15 As of December 2017, there were 88 teams in 17 states collecting and submitting data. Although the PCQN strives for geographic diversity among its members, the network originated in California, and teams within that state continue to make up a large portion of its members.…”

Section: Methodsmentioning

confidence: 99%