The care provided to individuals with serious, incurable disease can often be a painful, stressful struggle to maintain life. But many providers are opting to treat patients with chronic and terminal diseases using palliative care. Palliative care, as defined by the Center for Advanced Palliative Care (CAPC), focuses on providing patients with relief from symptoms, pain, and stress of a serious illness. The goal of palliative care is to improve the quality of life for the patient. Palliative care is not limited to hospice care, although the care provided by a hospice is palliative. The difference is that hospice care is focused on the dying process, while palliative care can be delivered in a variety of care settings to patients at various stages of treating the disease. Many palliative care patients recover or live longer then patients not receiving palliative care.
Kaiser Permanente health plans studied palliative care by offering enrollees in Los Angeles a palliative care benefit. Kaiser posted the outcome of its home-based model of palliative care coverage on the Innovations Exchange Website of the U.S. Agency for Healthcare Research and Quality (AHRQ). The Innovations Exchange Website provides health care professionals and researchers an opportunity to share, learn about and hopefully adopt evidence based innovations in the delivery of health care.
To be eligible for the demonstration, patients with Kaiser Permanente coverage had to have a primary diagnosis of cancer, congestive heart failure, or chronic obstructive pulmonary disease (COPD). The patients also had to be home-bound with a primary caregiver in the home and with a life expectancy of 12 months or less.
Kaiser found that the average cost of services for palliative care patients was significantly lower than conventional treatment of the same conditions. The cost of cancer treatment was 35 percent lower for patients who choose the palliative care coverage; 67 percent lower for palliative care patients with COPD; and 52 percent lower for palliative care patients with congestive heart failure. Kaiser found that 22 percent of palliative care patients visited the emergency room, while 33 percent of patients not enrolled in the palliative care benefit used the emergency department.Thirty-six percent of palliative care patients required hospitalization while 59 percent of patients not receiving palliative care were hospitalized. Kaiser found that the mean cost of palliative care patients was $12,670 while the mean cost of patients not receiving palliative care was $20,222.
Kaiser found that 80 percent of patients receiving the palliative care benefit were very satisfied with their care 30 days after they began receiving the benefit and that percentage grew to 93 percent of patients reported being very satisfied 90 days after enrolling. Seventy-one percent of palliative care patients died in their home while 51 percent of patients not enrolled in palliative care died in their home.
Assessment and Care
Palliative care patients in the Kaiser plan received an initial assessment that included a medical history, medication review, a physical assessment, and a home safety assessment by a nurse. The nurse discussed living wills and Do Not Resuscitate (DNR) orders. The nurse interviewed the patient and the family about their desires for end of life care.These conversations focused on pain management, alleviating stress and cultural and spiritual wishes. Although the program emphasized pain control and symptom management, patients did not have to forgo traditional curative care.
An interdisciplinary team including a physician, a palliative care nurse, a social worker and a chaplain administer the plan of care. Other providers are added to the interdisciplinary team as needed. Typically the patient receives a weekly visits from a nurse and visits by a physician usually once every 60 to 90 days.
Growth of Modality
Doctor Diane Meier, director of the CAPC, said in an article for WebMD that there are more than 1,400 hospital palliative care programs in the U.S. She continued to say that about 80 percent of US hospitals with more than 300 beds have a palliative care program, and that 55 percent of smaller hospitals with more than 50 beds also have a palliative care program. The vast majority of medical schools are now teaching medical students and residents about palliative care, according to Dr. Meier and that did not occur 10 years ago.