Hospitalists and Palliative Care: A Win-Win Partnership

1
Hospitalists and Palliative CareA Win-Win
Partnership

• Steven Pantilat, MD
• Eva Chittenden, MD
• Palliative Care Program and Palliative Care
  Leadership Center
• Hospitalist Division
• Department of Medicine
• University of California, San Francisco

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Hospitalists and Palliative Care Alignment of
Goals

• Both groups are dedicated to
• Improving quality of care
• Increasing patient and family satisfaction
• Enhancing appropriate allocation of resources
• Supporting hospital priorities
• Increasing efficiency
• Passing JCAHO visit

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Link Between Hospitalists and Palliative Care

• Half of Americans die in hospitals
• Many more have chronic illness and palliative
  care needs
• 98 of Medicare decedents spent at least some
  time in the hospital in the last year of life
• Hospitalists are becoming the de facto
  providers of palliative care for many
  hospitalized patients

4
Advantages of Hospitalists for Inpatient
Palliative Care

• Small group of physicians cares for most
  inpatients
• Care for patients throughout the hospital
• Present in the hospital
• Understand how hospital systems works
• Familiar with the cost savings financial
  argument
• Accustomed to working with interdisciplinary teams

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Hospitalists and Palliative Care

• Hospitalists have defined palliative care as a
  core competency
• Hospitalists recognize importance of palliative
  care
• Presence of hospitalists associated with success
  in starting palliative care program

Pantilat et al. Arch Int Med 2006166227-30
6
Hospitalists and Palliative Care
4.7
4.8
4.6
3.3
Plauth et. al. Am J Med, 2001111247-54
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Evidence that Hospitalists May Improve Palliative
Care

• Academic-affiliated, community hospital with
  housestaff
• Of patients who died, those cared for by staff
  hospitalists vs. community physicians
• Had fewer symptoms in last 48 hours of life
• Were more likely to have communication regarding
  care (91 vs. 73)

Auerbach and Pantilat Am J Med 2004116669-75
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How Hospitalists Contribute to a Palliative Care
Service

• Lead implementation of a palliative care service
• Join a team planning a palliative care program
• Join an existing palliative care team
• Become a palliative care consultant to other
  physicians including hospitalists
• Refer patients to an existing palliative care
  service
• Support the establishment of a palliative care
  service
• Participate in guideline development and quality
  improvement in palliative care

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Reasons That a Hospitalist Would Do Palliative
Care

• Add variety to job
• Do more of what you are good at and like
• Personal and professional satisfaction
• Work with great interdisciplinary team
• Diversify funding stream
• Palliative care pro-fee billing
• Institutional support
• Acquire expertise within generalism
• Help institution achieve prestige, quality, and
  other goals

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Challenges for Hospitalists to Participate in
Palliative Care

• Lack training and expertise in palliative care
• Cannot provide continuity of care
• See a limited spectrum of end-of-life care
• Immersed in culture of the hospital

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Challenges for Hospitalists to Participate in
Palliative Care

• Most hospitalist programs are extremely busy
• No excess capacity to add palliative care
• Consider nurse clinical leader to lessen demand
  on hospitalist
• Combine palliative care with another activity
  to create a full days work
• Secure funding to support participation of
  hospitalists

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Overcoming Challenges

• Support clinical training in palliative care for
  hospitalists
• Goal of palliative care board certification for
  all participating hospitalists
• Recruit more than one hospitalist
• Account for days off
• Get technical assistance in starting a palliative
  care program
• Palliative Care Leadership Center

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Palliative Care Educational Resources- Clinical

• EPEC Project
• http//www.epec.net/EPEC/webpages/index.cfm
• AAHPM Educational Programs
• http//www.aahpm.org/education/index.html
• Harvard PCEP Program
• http//www.hms.harvard.edu/cdi/pallcare/
• Online and written materials
• http//www.capc.org/palliative-care-professional-d
  evelopment
• http//www.eperc.mcw.edu/index.htm

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Palliative Care Leadership Centers

• Technical assistance for establishing palliative
  care programs
• Focus on hospitalists and palliative care at UCSF
  PCLC
• 6 sites around the country
• For info www.capc.org

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Conclusion

• There is a natural link between hospitalists and
  palliative care in improving quality of care,
  satisfaction, and resource utilization for
  seriously and terminally ill hospitalized
  patients
• Hospitalists can lead, participate in, or refer
  to a palliative care service
• Palliative care can contribute to hospitalist job
  diversity and satisfaction
• To succeed, hospitalists need to obtain clinical
  expertise and programs need technical assistance
• Ultimately a win-win for all involved-
  hospitalists, palliative care programs,
  hospitals, and patients