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Palliative Care for Heart Failure

Palliative Care for Heart Failure. Tiffani Schmitz RN, BSN, MSM Marie Cunningham BSM. Objectives. Describe the admission history and pattern of patients with end stage heart disease in the last twelve months of life as identified by research results.

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Palliative Care for Heart Failure

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  1. Palliative Care for Heart Failure Tiffani Schmitz RN, BSN, MSM Marie Cunningham BSM

  2. Objectives • Describe the admission history and pattern of patients with end stage heart disease in the last twelve months of life as identified by research results. • Identify an evidence based, quantifiable measure to determine the most appropriate time to refer to palliative care or hospice care. • Describe key palliative interventions for patients with end stage heart disease.

  3. Industry Trends • Number of deaths from chronic illness is approximately 70% • NHPCO estimates nearly 41.6% of all deaths in the US were under the care of a hospice program * 2,450,000 US Deaths 1,020,000 Hospice Deaths 41.6% *NHPCO Data 2009

  4. US Causes of Death 2010 CDC

  5. Percentage of Hospice Admissions by Primary Diagnosis 2010 NHPCO Facts and Figures on Hospice Care

  6. Important Needs Going Unmet

  7. Late Referrals Undermine Hospice Value

  8. The 2010 HF Society of America Comprehensive HF Practice Guidelines

  9. Challenges in Determining “End of Life”

  10. Challenges in determining “End of Life” Would I be surprised if my patient died within the next twelve months? BMJ 2000; 320: 469-473

  11. Prognosis Stays Uncertain Through Most of the Last Part of Life 0.8 Congestive heartfailure 0.6 Median 2-month Survival Estimate 0.4 Lung cancer 0.2 0.0 7 6 5 4 3 2 1 Days before Death * From SUPPORT, 1988-93

  12. The Research

  13. Key Outcome

  14. Financial Implications

  15. Average Number of Admissions

  16. Mean Admissions for Heart Patients 22

  17. Cost of Readmission within 30 Days

  18. Healthcare Reform Act

  19. Hospice vs. Palliative Care Palliative Care Curative Care Comfort Care Hospice Care

  20. Why Focus on End Stage Heart Disease?

  21. Trend of the HF patient • New Orientation • New normal • Most are not ready for “newness” • Creating moments of joy; healing happens and may be seen as a gift and a surprise • Promote openness and understanding • Disease is in the background • Orientation • Status quo • Symptom exacerbation • In and out of acute care • With every admission may hit ‘new normal’ but maintaining at a new low • Disease is the focus • Disorientation • Bad news-chaos • No language • Unfamiliar territory • Too difficult, too hard, too scary, too visceral

  22. Comparing Hospice and Nonhospice Patient Survival Hospice care resulted in an average increase of life by 29 days. 81 Days 39 Days 21 Days Retrospective statistical analysis of 4493 patients from 5% of Medicare patients from 1998-2002 Connor SR et al. JPSM 2007; 33:238-46

  23. What does 81 days mean to your patients?

  24. End of Life Conversations Alone Have Positive Impact • Advance cancer patients who had EOL discussions showed 35.7% in lower costs than those with no EOL discussions • Those who discussed EOL showed: • 1 Higher tendency to want to know life expectancy • 2 Acknowledgement of terminal illness • 3 Less likely to favor futile care over comfort • 4 Preference to avoid dying in the ICU • 5 Higher likelihood to receive outpatient hospice care and earlier referral Source: Health Care Costs in the Last Week of Life: Associations with EOL Conversations, Arch Inter Med 2009

  25. Rate of Readmission for Heart Failure Patients Within 30 Days Number of Patients 103 403 319 584 Medicare data on patient discharged between July 1, 2006 and June 30, 2009. Hospitalcompare.hhs.gov HOC data from Jan 2011 though October 2011

  26. Pathways for End Stage Heart Disease • Effectively manage symptoms and avoid hospital re-admissions • Nursing visits • Cardiac medications • Focus on patient and caregivers • 24/7 Support Team • Meet all levels of care Implement a plan of care to create a positive and meaningful end of life experience

  27. Nursing Visits

  28. Medications

  29. Caregiver Focus

  30. 24/7 Availability

  31. End of Life Program Yields Dramatic Improvement in Hospice Referrals and Hospital Admissions Goal: To identify patients early in the process so that referral to appropriate care and related community resources occurs in a timely fashion. Source: Advisory Board, Franciscan Health System, Tacoma, Wash

  32. Meet all levels of care

  33. Palliative Care Saves Money and Improves End of Life Experience 1Increasing Satisfaction with Care and Lower Costs: Results of a Randomized Trial of In-Home Palliative Care JAGS, The American Geriatrics Society, 2007

  34. Help patients understand their options

  35. Create a plan for your patients

  36. Thank You (513) 891-7700

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