When you discover your mortality rates for stroke, pneumonia and heart failure aren’t where they need to be, what do you do?
The quality team at Carson Tahoe Health, a health system based in northern Nevada and eastern California, recently faced that challenge — and knew they had to answer two key questions: why is this happening and what can we do about it?
After a concentrated chart review, the health system discovered that the majority of patients who died in their care were at the end stages of their diseases.
Recent studies had pointed to the implementation of palliative care as a way to improve patient care and lower mortality rates. So to test the theory in their own environment, Carson Tahoe Health decided to roll out an inpatient care protocol in which hospitalists refer patients with end-of-life issues to a palliative care physician.
Comparing outcomes to determine progress
Using a clinical performance monitoring and benchmarking solution, the quality team was able to analyze several metrics, focusing on heart failure and chronic obstructive pulmonary disease (COPD) diagnosis-related groups in end stages of the diseases.
They tracked two groups of patients: those who participated in the palliative care protocol and those who did not. That way, cost, utilization, readmission, length of stay and other comparisons could be made.
The health system gained some key insights on the value of palliative care:
To see if they could move the dial even further on care improvement, the health system built and analyzed population reports to review the potential return on investment for an outpatient palliative program.
Informing the next step
With the new data and reports in hand, the health system proposed an outpatient palliative care service line to its board of directors, and the board approved it. Now Carson Tahoe Health offers a palliative care/heart failure chronic disease management clinic that sees patients within five days of discharge.
After implementing the palliative care initiatives, the health system’s 30-day inpatient mortality rates for acute myocardial infarction, heart failure, COPD, pneumonia, stroke and coronary artery bypass graph surgery began trending lower than the national average.
They plan to expand palliative care services to other chronic end-stage disease groupings in the future.
If you’d like more information on how the health system achieved these results, . You can also read the .