National Landscape of Hospital-Based Palliative Care: Findings from the National Palliative Care Registry™

Maggie Rogers, MPH Senior Research Associate, CAPC Tamara Dumanovsky, PhD VP Research & Analytics, CAPC July 13, 2017

The National Palliative Care Registry™ is building a profile of palliative care teams, operations, and service delivery. The Registry is free and open to all palliative care programs across service delivery sites.

The National Palliative Care Registry™ is a joint project of the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC). CAPC Membership is not required to participate.

U.S. Hospital-based Palliative Care

Registry National Participation

Today’s Webinar Topics:

• Growth in palliative care service penetration • Trends in staffing and findings on the most

prevalent staffing models today • Changes in referral sources, in terms of referring

specialists and patient locations • Insight on patient demographics and primary

diagnosis categories • Findings on length of stay and timing of patient

visits

Participation, 2016 • Trends report on over 3,000 surveys • For 2016 findings, 351 completed surveys on

adult palliative care programs were included • Analyses were limited to:

– surveys with at least total initial consults answered – adult or mixed adult/pediatric palliative care

programs • Pediatric palliative care programs can find key

2016 findings in our upcoming July blog post in CAPC’s Palliative in Practice

Key Findings from the Registry

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 in hospitals are reaching patients in need.

Total number of annual hospital admissions

Total number of patients who received a palliative care consult

Palliative Care Service Penetration

2.6 2.7 2.8 3.1

3.5

4.0

4.4

4.8 5.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

2008 2009 2010 2011 2012 2013 2014 2015 2016

Mean Penetration Median Penetration

Palliative Care Penetration, 2016

6.8

4.8

3.8

0.0

2.0

4.0

6.0

8.0

<150 beds(n=67)

150-499 beds(n=202)

500+ beds(n=82)

Mean Penetration

Median Penetration

343 average initial consults

718 average initial consults

1,274 average initial consults

Palliative Care Staffing, 2016

3%

3%

4%

4%

5%

6%

7%

8%

12%

14%

32%

34%

36%

51%

66%

69%

80%

88%

0% 20% 40% 60% 80% 100%

Massage Therapist

Child Life Specialist

Resident

Music/Art Therapist

Physical & Occupational Therapist

Ethicist

Nutritionist

Hospice Liaison

Fellow

Pharmacist

Support Staff

Medical Director

Administrator (non-clinical)

Registered Nurse

Chaplain

Social Worker

Advanced Practice Registered Nurse

Physician (MD/DO)

Percentage of Programs with Discipline on Their Team

Core Palliative Care Interdisciplinary Team (IDT)

Staffing Recommendations Standards set by the Joint Commission Advanced Certification for Palliative Care state that the core interdisciplinary team (IDT) should include, at a minimum:

• Physician • Advanced Practice or other Registered Nurse • Social Worker • Chaplain

31% 31%

39%

37%

41% 41%

44%

50%

2009 2010 2011 2012 2013 2014 2015 2016

Percentage of programs reporting a “full” IDT

Staffing Recommendations, 2016 Percentage of programs reporting a “full” IDT, by hospital size:

42.4% 46.5%

63.6%

0%

20%

40%

60%

80%

100%

<150 beds 150-499 beds 500+ beds

Larger hospitals are somewhat more likely to meet staffing recommendations

IDT Full-Time Equivalent

2.1 2.2

2.7

3.7 3.8

7.6

0.0

2.0

4.0

6.0

8.0

10.0

2009 2010 2011 2012 2013 2014 2015 2016

Mea

n F

ull-

tim

e Eq

uiv

alen

t (F

TE)

<150 beds

150-499 beds

500+ beds

All Staff Full-Time Equivalent

2.8 2.7

3.0

4.4 4.4

9.4

0.0

2.0

4.0

6.0

8.0

10.0

2009 2010 2011 2012 2013 2014 2015 2016

Mea

n F

ull-

tim

e Eq

uiv

alen

t (F

TE)

<150 beds

150-499 beds

500+ beds

Avg +1.8 FTE beyond IDT

Avg +0.7 FTE beyond IDT

Avg +0.5 FTE beyond IDT

IDT FTE by Hospital Size

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

2009 2016 2009 2016 2009 2016

<150 Beds 150-499 beds 500+ beds

Mea

n F

ull-

tim

e Eq

uiv

alen

t (F

TE)

2.1 2.2

2.7

3.7 3.8

7.6

IDT FTE by Hospital Size

0.5 0.5 0.7 0.9 1.3

2.5

0.4 0.7

0.7

1.2 1.0

2.3

0.5 0.5

0.6

0.6 0.6

1.0

0.3 0.2

0.3

0.4 0.3

0.6

0.4 0.3

0.4

0.6 0.6

1.2

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

2009 2016 2009 2016 2009 2016

<150 Beds 150-499 beds 500+ beds

Mea

n F

ull-

tim

e Eq

uiv

alen

t (F

TE)

Social Worker

Chaplain

RN

APRN

Physician

Across hospital sizes, much of the growth in pal care IDTs is attributable to an increase in APRNs

Growth in physician, chaplain, and social worker staffing was primarily limited to larger hospitals where each discipline more than doubled

Relationship between IDT Staffing and Penetration, 2016

3.4

4.1

4.7

6.6

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

< 1.5 1.5 - 2.0 2.1 - 3.0 >3.0

Interdisciplinary Palliative Care Team FTE per 10,000 Hospital Admissions

Mean Penetration

Median Penetration

Palliative care programs with more than 3.0 interdisciplinary team FTE per 10,000 admissions have a penetration rate nearly double that of programs in the smallest IDT FTE group (less than 1.5 FTE per 10,000 admissions).

Patient Demographics

0.3

5.5

22.9

48.7

22.0

Patient Age

Less than 18 years old

18 - 44 years old

45 - 65 years ago

65 - 85 years old

Over 86 years old

13.3

75.6

2.5 1.2 4.3 2.7

Patient Ethnicity

Black/African American

White/Caucasian (Non-Hispanic)

Asian

American Indian/Alaska Native

Hispanic/Latino

Other

For participating programs, nearly half of all patients were between the ages of 65 and 85 years old.

For participating programs, over three-quarters of patients were non-Hispanic White/Caucasian.

Primary Diagnosis Category, top 7

27%

13% 12%

8%

6% 6% 5%

0%

10%

20%

30%

Cancer Cardiac Pulmonary Neurological Infectious ComplexChronic

Dementia

For participating programs, on average, one in four palliative care patients had a primary diagnosis of cancer.

Top 4 Referrals, 2016

43%

26%

13%

8%

0% 20% 40% 60%

Medical/Surgical Unit

Intensive Care Unit

Step-down Unit

Oncology Unit

53%

12%

12%

7%

0% 20% 40% 60%

Hospital Medicine

Internal/Family Medicine

Pulmonary/Critical Care

Oncology

Mean % of Patients Referred from…

Referring Sites

Referring Physician Specialties

Changes in Top Referrals Sources

51.0 52.2 55.6

48.9 53.5

0

10

20

30

40

50

60

2012 2013 2014 2015 2016

Hospitalist Referrals

42.1 43.5 45.7

41.0 42.8

2012 2013 2014 2015 2016

Med/Surg Referrals

Referring sites and referring physician specialties have not really changed since 2012. Palliative care patients are still being referred by the same sites and the same specialties.

Program Features, 2016

of programs use standardized screening criteria (trigger) to identify potential pal care patients

of programs provide 24/7 coverage, with Monday-Friday inpatient consultation and 24/7 telephone support

of programs reported getting custom palliative care reports from their Electronic Health Record (EHR)

of programs reported having a quality improvement (QI) plan in place

29%

43%

49%

73%

Length of Stay, Discharged Alive(79%), 2016

2.9

4.3

5.0

5.8

4.2

5.0

5.2

6.8

0.0 5.0 10.0 15.0

<150 beds

150-299 beds

300-499 beds

500+ beds

Total Days

Time to Consult Consult to Discharge

Length of Stay, Died in Hospital (21%), 2016

3.5

5.2

5.8

7.5

4.5

4.6

4.7

5.3

0.0 5.0 10.0 15.0

<150 beds

150-299 beds

300-499 beds

500+ beds

Total Days

Time to Consult Consult to Discharge

Response & Engagement, 2016

of patients received a palliative care consult within 1 day of hospital admission

of patients received a palliative care consult within 1 day of referral

of referred patients were not seen by the palliative care program prior to hospital discharge or death

31%

68%

6%

Discharge Locations, 2016

25.9

13.7

6.4 7.1

0.0

10.0

20.0

30.0

40.0

50.0

Home (includinghome hospice &assisted living)

Skilled NursingFacility

Inpatient orResidential Hospice

Long-term AcuteCare, Rehab or

General Hospital

Other or UnknownLocations

One-third of patients discharged home received hospice

47.0

Coming Soon… to a Community near You!

• National Palliative Care Registry™ reports for the expanded surveys on community-based palliative care programs

• “Make your Mark” with Mapping Community

Palliative Care, CAPC’s new initiative to identify all community-based palliative care programs across the country

Website: registry.capc.org Email: registryhelpdesk@capc.org Phone: 212-201-2689 The Registry is FREE and open to all palliative care programs. CAPC Membership is NOT required to participate. Pediatric Blog will be available here: https://palliativeinpractice.org/

National Palliative Care Registry™