Case Study 3: Palliative & Hospice:
Unnecessary Admissions & In-hospital Mortality Rates

Challenge:
In the U.S., more than 50 percent of patients die in a hospital. Since studies have long shown that more than 90 percent of patients would prefer to die peacefully at home with hospice services in place, different strategies are needed by physicians and other caregivers. Needless end-of-life suffering and wasteful spending in the billions of dollars must be avoided whenever possible.

Actions Taken/Approach to Solutions:
In our network, 44 percent of patients were dying with hospice in place—which was seen to be considerably better than the national incidence norms, but still not good enough. Subsequently, health information technology data stratified the patient population for likelihood of admission to the hospital in the next six to 12 months. The sickest patients were visited at home by nurse practitioners; for patients who were deemed to be less seriously ill, nurse care managers provided assistance by phone. Physicians were educated about the various indications for palliative care and hospice care.

Results:
Visits to the Emergency Department and subsequent hospitalizations decreased; a positive trend toward the use of palliative care and hospice was seen, resulting in increased quality of care and decreased cost. (Actual numbers for these changes are proprietary; therefore, are not provided.)

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