suffering at end of life: michigan status report & recommendations kay presby mph rn pain &...
Post on 21-Jan-2016
221 Views
Preview:
TRANSCRIPT
Suffering at End of Life:Suffering at End of Life:Michigan Status ReportMichigan Status Report& Recommendations& Recommendations
Kay Presby MPH RNKay Presby MPH RNPain & Symptom Management Committee 02.08.07Pain & Symptom Management Committee 02.08.07
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 22
Data SourcesData Sources
2004 EOL Needs Assessment2004 EOL Needs Assessment 50 Stakeholder & 57 hospice mgr interviews50 Stakeholder & 57 hospice mgr interviews 2002 Michigan Resident Death File2002 Michigan Resident Death File
2004 Special Cancer Behavioral Risk Factor 2004 Special Cancer Behavioral Risk Factor Survey, EOL ModuleSurvey, EOL Module Even years, phone, MPHI & MSU IPPSREven years, phone, MPHI & MSU IPPSR
2006 Census of Hospital-Based Palliative 2006 Census of Hospital-Based Palliative Care ProgramsCare Programs
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 33
Project SponsorsProject Sponsors
Michigan Dept of Community HealthMichigan Dept of Community Health Michigan Public Health Institute Michigan Public Health Institute Michigan Hospice & Palliative Care Michigan Hospice & Palliative Care
OrganizationOrganization Michigan Cancer ConsortiumMichigan Cancer Consortium
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 44
Good NewsGood News
InfrastructureInfrastructure Expert professionalsExpert professionals Model programsModel programs Palliative care teamsPalliative care teams
A
EOL Pain Policy
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 55
Location of Hospital-Based PC TeamsLocation of Hospital-Based PC Teams
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 66
Good NewsGood News
InfrastructureInfrastructure Expert professionalsExpert professionals Model programsModel programs Palliative care teamsPalliative care teams
Public AwarenessPublic Awareness 90% aware of hospice90% aware of hospice 60% use hospice60% use hospice
A
EOL Pain Policy
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 77
Disappointing NewsDisappointing News
Policy has had little impact on practice.Policy has had little impact on practice. Hospice length of service is dropping.Hospice length of service is dropping.
1/3 die before one week1/3 die before one week Median LOS is 18 daysMedian LOS is 18 days
Needless suffering still is widespread in Needless suffering still is widespread in Michigan.Michigan.
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 88
Who says so?Who says so?
Michigan Michigan Commission Commission on EOL Care, on EOL Care, 20022002
Stakeholders, Stakeholders, 20042004(n=50)(n=50)
““The lack of effective pain The lack of effective pain and symptom management and symptom management is a public health issue that is a public health issue that requires the highest level of requires the highest level of professional and regulatory professional and regulatory attention.”attention.”
80% named eliminating 80% named eliminating unnecessary suffering as the unnecessary suffering as the top end of life priority.top end of life priority.
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 99
Who says so?Who says so?
Hospice Hospice managers, managers, 20042004
Patients & Patients & families, families, 20042004
90% ~ Pain management is a 90% ~ Pain management is a problem in their service area.problem in their service area.
48% ~ At least half of patients 48% ~ At least half of patients admitted in severe pain (6+).admitted in severe pain (6+).
Why not before?Why not before? Why doesn’t anyone else Why doesn’t anyone else
know?know? How could you do this so How could you do this so
quickly?quickly?
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 1010
Place of Death by Age, Michigan 2002Place of Death by Age, Michigan 2002
34%
46%
52%
52%
46%
47%
27%
13%
24%
18%
25%
32%
34%
27%
5%
0% 100%
85+
75 - 84
65 - 74
<65
All
Age
at D
eath
Percentage of Deaths by Site
Hospital Nsg Home Home Other
Michigan Resident Death File, 2002Michigan Resident Death File, 2002
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 1111
Distribution of Decedents, Distribution of Decedents, Any Terminal IllnessAny Terminal Illness, by Site , by Site & Avg Pain Level for Final 3 Months,& Avg Pain Level for Final 3 Months, MI 2004 BRFSMI 2004 BRFS
0 10 20 30 40 50 60 70 80
Other (N = 16)
Hospice Building (N = 14)
Hospital (N = 62)
Nursing Home (N = 85)
Home Setting (N = 524)
All Locations (N = 701)
Percentage
None Mild to Moderate Severe to Excruciating
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 1212
Back of the envelope…Back of the envelope…
87,50087,500
61,25061,250
23,27523,275
Average annual count of Average annual count of deaths in Michigandeaths in Michigan
70% die of chronic disease70% die of chronic disease
38% live their final 3 months 38% live their final 3 months with severe to excruciating with severe to excruciating pain, as reported by pain, as reported by caregiverscaregivers
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 1313
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 1414
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 1515
Put a face on the suffering…Put a face on the suffering…
The person in pain todayThe person in pain today
does not have to waitdoes not have to wait
for a better drugfor a better drug
to be developed ~ to be developed ~
he just needs someonehe just needs someone
to prescribe correctlyto prescribe correctly
what we already know.”what we already know.” (Joanne Lynn, MD, 2000)(Joanne Lynn, MD, 2000)
Goldie ~ Detroit metroGoldie ~ Detroit metro Tom ~ western MichTom ~ western Mich Henry ~ mid MichiganHenry ~ mid Michigan James ~ northern MIJames ~ northern MI Colleen ~ thumbColleen ~ thumb
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 1616
Invisible to Health Care System?Invisible to Health Care System?
Not according to Wennberg study of intensity Not according to Wennberg study of intensity of services during final 6 mos for Michigan of services during final 6 mos for Michigan Medicare decedents in 1995-96:Medicare decedents in 1995-96: 15% to 45% were admitted to ICU15% to 45% were admitted to ICU Average no. of physician visits: 16 to 34Average no. of physician visits: 16 to 34 Up to 33% saw 10+ physiciansUp to 33% saw 10+ physicians
Dartmouth Atlas of Health Care in Michigan, 2000; Dartmouth Atlas of Health Care in Michigan, 2000; http://www.bcbsm.orghttp://www.bcbsm.org
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 1717
Then why the suffering?Then why the suffering?Input from interviewed hospice managers (n=57):Input from interviewed hospice managers (n=57):
90%90% Protocol doesn’t fit type or intensity of Protocol doesn’t fit type or intensity of pain ~ wrong drug, dose, frequencypain ~ wrong drug, dose, frequency
70%70% Lack of clinician knowledge re: opioid drugsLack of clinician knowledge re: opioid drugs
& dosing, atypical pain; RN reluctance& dosing, atypical pain; RN reluctance
30%30% Pain med not taken as directedPain med not taken as directed
10%10% Side effects, fear of addictionSide effects, fear of addiction
End of Life in Michigan, Needs Assessment Report, 2005End of Life in Michigan, Needs Assessment Report, 2005
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 1818
Critical Issues to AddressCritical Issues to Address
Undertreatment of pain has not been Undertreatment of pain has not been embraced as an urgent problem in Michigan.embraced as an urgent problem in Michigan.
Clinicians can’t do what they don’t know.Clinicians can’t do what they don’t know. Hospitals are slow to embrace palliative care Hospitals are slow to embrace palliative care
as a clinical and business priority.as a clinical and business priority. Nursing homes struggle with pain mgt and Nursing homes struggle with pain mgt and
hospice is not often used.hospice is not often used. Consumers expect to suffer. Consumers expect to suffer.
They don’t know that pain is optional at the They don’t know that pain is optional at the end of life.end of life.
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 1919
Key RecommendationsKey Recommendations
Public Health AdministrationPublic Health Administration Establish an end-of-life unit within the Division Establish an end-of-life unit within the Division
of Chronic Disease and Injury Control to:of Chronic Disease and Injury Control to: Monitor population needsMonitor population needs Foster alliances and convene partners for Foster alliances and convene partners for
coordinated actioncoordinated action Organize and galvanize statewide actionOrganize and galvanize statewide action Coordinate action among state unitsCoordinate action among state units
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 2020
Key RecommendationsKey Recommendations
Bureau of Health Professions:Bureau of Health Professions: Require CME in pain mgt for license renewal.Require CME in pain mgt for license renewal. Adopt the 2004 FSMB model pain policy.Adopt the 2004 FSMB model pain policy.
Bureau of Health Systems:Bureau of Health Systems: Require access to hospice services in all Require access to hospice services in all
nursing homes.nursing homes. Establish an M-tag for pain management.Establish an M-tag for pain management.
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 2121
Key RecommendationsKey Recommendations
Medical Services Administration:Medical Services Administration: Assure coverage and reimbursement for hospice and Assure coverage and reimbursement for hospice and
palliative care services by all health plans.palliative care services by all health plans. Require access to palliative care consults in network Require access to palliative care consults in network
hospitals; board-certified physicians (ABHPM) and hospitals; board-certified physicians (ABHPM) and nurses preferred (CHPN, BCPCM).nurses preferred (CHPN, BCPCM).
Division of Chronic Disease & Injury ControlDivision of Chronic Disease & Injury Control Wage a sustained community organization campaign Wage a sustained community organization campaign
to prepare consumers to expect and demand effective to prepare consumers to expect and demand effective pain control.pain control.
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 2222
Essential StrategiesEssential Strategies
Make it easy to do the right thingMake it easy to do the right thing SystemsSystems
Give the policy teethGive the policy teeth ConsequencesConsequences
Make a plan and Make a plan and assure actionassure action Communicate, implement, sustain, monitorCommunicate, implement, sustain, monitor
Pain & Sx Mgt Commiittee 02.08.07Pain & Sx Mgt Commiittee 02.08.07 2323
End-of-Life Needs Assessment ReportEnd-of-Life Needs Assessment Report
Available online at the Michigan Cancer Available online at the Michigan Cancer Consortium website ~Consortium website ~
http://www.michigancancer.org/OurPriorities/http://www.michigancancer.org/OurPriorities/EndOfLifeCare_InformationForProviders.cfmEndOfLifeCare_InformationForProviders.cfm
top related