palliative care metrics what, how &...
TRANSCRIPT
8/24/2015
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PALLIATIVE CARE METRICS
WHAT, HOW & WHY
Debby Greenlaw, MS, ACHPN, ACNPC
Goals
Identify an example from each type of metric
category
Operational, clinical, customer, financial
Describe 3 practical uses for data reporting
Describe at least one new metric or metric report
you will implement in the coming year
Why Collect Data?
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Why Collect Data?
Strategic planning/ Accommodating growth
Demonstration of program impact
Assess effectiveness of program outreach
Quality improvement
Benchmarking and comparison with other programs
Apply for grants & other funding
Conduct research
Only collect the data you need. If you don’t use
it, don’t collect it.
What Data Should be Collected?
Operational
Patient Demographics
Age, Gender, Ethnicity
Day of Consult
Diagnosis
Location
Referring Physician/Service
Hospital Length of Stay
Disposition
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Operational Metrics
Jan-Mar Apr-Jun Jul-Sep Oct-Dec TotalPALLIATIVE CARE CONSULT ORIGIN % % % % %
Medical 17 6 12 4 10
Surgical 0 2 4 6 3
Emergency Department 2 0 6 4 3
Intensive Care Unit (ICU) 20 35 31 39 31
Cardiology ICU 20 18 21 12 18
Telemetry / Step Down 41 39 27 35 36GENDER % % % % %
Male 36 42 42 29 38
Female 64 58 58 71 62RACE/ETHNICITY % % % % %
Asian/Pacific Islander 0 0 0 0 0
African American/Black 41 42 42 39 41
Caucasian 59 53 58 61 58
Hispanic/Latino 0 0 0 0 0
Native American/Alaskan Native 0 0 0 0 0
Other Race/Ethnicity 0 5 0 0 1AGE % % % % %
Age: 18-64 years 25 15 25 22 22
Age: 65-85 years 47 59 48 53 52
Age: 86 years or more 28 26 27 24 26
Operational Metrics
Jan-Mar Apr-Jun Jul-Sep Oct-Dec Total
NUMBER OF CONSULTS 64 66 52 49 231
NUMBER OF NON-CONSULT VISITS 111 117 117 125 470
*** Family meeting 43 31 36 36 146
*** Nurse 18 15 11 34 78
*** NP 50 71 70 54 245
BILLABLE VISITS 100 107 99 94 400
NON-BILLABLE VISITS 75 76 70 80 301
TOTAL ENCOUNTERS 175 183 169 174 701
Referrals by Provider
Requesting Provider Number of
Referrals
New Referrer in 2014
Medical Specialty
Tarekegne,Mulugeta 28 Hospitalist
Cauthen,Carlton Gregory 26 Pulmonary
Udoh,Moses Eliza 16 Hospitalist
Zamcho,Anthony 14 Hospitalist
Harden,Oliver Pierre 11 Hospitalist
Vidal,Rachel W 10 Hospitalist
Ansani,Monica Amankwaa 9 Hospitalist
Gottipaty,Venkateshwar Kotiah 9 Cardiology
Ghent,William S. 7 Pulmonary
Henderson Jr.,Frampton Wyman 6 Family Practice
Ambroziak,Jeremy Mark 5 Family Practice
Perry,Christopher David 5 Pulmonary
Robinson, Jerry 5 X Internal Medicine
Barnick,Vaughn Rex 4 Internal Medicine
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Financial
Length of stay (hospital & ICU)
Length of stay after palliative care consultation
Total cost per day before & after consultation
Pharmacy costs per day, before & after consultation
Length of Stay
Average days admission to palliative care consult 6.2
days (range 0-74 days); median is 4 days, mode is 1
day.
Average length of stay palliative care consult to
discharge 4 days (range 0-36 days; removing 1 outlier
of 108 days). Median is 2 days, mode is 0 (same day).
Clinical
Pain & Symptom Control
Documentation of Advance Care Planning
Psychosocial Assessment
Spiritual Assessment
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Measuring What Matters: Top-Ranked Quality Indicators for Hospice and Palliative Care
From the American Academy of Hospice and Palliative Medicine and Hospice and
Palliative Nurses Association
Sydney Morss Dy, MD, MSc, Kasey B. Kiley, MPH, Katherine Ast, MSW, LCSW, Dale Lupu, PhD, Sally A. Norton, PhD, RN, FAAN,
Susan C. McMillan, PhD, ARNP, FAAN, Keela Herr, PhD, RN, AGSF, FAAN, Joseph D. Rotella, MD, MBA, FAAHPM, David J. Casarett,
MD, MA
Journal of Pain and Symptom Management
Volume 49, Issue 4, Pages 773-781 (April 2015) DOI: 10.1016/j.jpainsymman.2015.01.012
Copyright © 2015 American Academy of Hospice and Palliative Medicine
Journal of Pain and Symptom Management 2015 49, 773-781DOI: (10.1016/j.jpainsymman.2015.01.012)
Customer
Patient and family satisfaction
Referring provider satisfaction
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Pilot Survey-Patient/Family Satisfaction
Nov 2014
Dec 2014 Total
Number of surveys 9 5 14
Completed surveys 8 5 13
Unable to reach 1 0 1
Refused 0 0 0
Did the patient have pain or take medicine for pain? % % %
Yes 88 80 85
No 13 20 15Did you or your family receive information from the medical care team about the medicines that were used to manage the patient’s pain?
Yes 88 80 85
No 0 0 0
Don't know 0 0 0Did the patient have trouble breathing?
Yes 63 80 69
No 38 20 31Did you or your family receive any information from the medical care team about what was being done to manage the patient’s trouble with breathing?
Yes 63 80 69
No 0 0 0
Don't Know 0 0 0
Provider Satisfaction Survey
Poor Fair Good Very Good Excellent
1. How would you rate the response time of the
Palliative Care service to your referrals?
Comments: Sometimes with the number of referrals, and
time constraints, a day later but with the
type of patient, not harmful. “She needs
more help.”
0 0 2 8 16
2. How would you rate the communication
between you and the Palliative Care Service?
0 0 1 6 19
3. How would you rate the helpfulness of
Palliative Care service recommendations?
0 0 1 8 17
4. How would you rate the benefit of the
Palliative Care service to your patients and
families?
Comments: What a help to the family and the patient!
(Of course me too).
Always helpful to work with a difficult
situation and often stressful situation.
Patients and family express deep gratitude
for the service provided.
0 0 2 5 19
How to Collect Data
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Databases
Work well for Operational & Financial Data
Interface with Clinical Record?
Work with Accounting/Finance Department
Excel or Microsoft Access
Process & Outcome Measures
Work best with Clinical & Customer Metrics
Process Measures are activities carried out to
deliver services; often guided by evidence-based
clinical guidelines.
Outcome Measures show performance and impact
on the patient.
Tools are used to collect these measures.
Symptom Assessment
Process Measure
Review documentation for frequency of documentation
& missing elements within documentation
Outcome Measure
Symptom scores
Data Collection Tool
Edmonton Symptom Assessment Scale
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If you don’t know where you’re going, you’ll
probably get lost.
-- Yogi Berra
Reporting Program Metrics
Once you collect the data how do you use it to
influence practice changes?
When sharing data with stakeholders, make the
data personal. Share it in terms of number of
patients impacted not just percentages.
Program Growth
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National Palliative Care Registry*
Three Key Registry Metrics
➔Palliative Care Service Penetration
➔Staffing Levels / Interdisciplinary Teams
➔Time to Consult / Length of Stay
* CAPC Center to Advance Palliative Care
Palliative Care Service Penetration
Palliative Care Staffing Ratios
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Length of Stay
Top MS-DRGs with Palliative Care Consults
Septicemia w/MCC (MS-DRG 871) patients receiving palliative care
consults cost ~$5,300 less and stay ~2.8 days less than expired patients
not receiving a PC consult.
PC Impact on Total Cost per Case – Septicemia w/MCC
**Labels in the bottom view of the dashboard represent the number of days between admission and palliative care consult.
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Patients with septicemia or severe sepsis w/o MV 96+ hours w/MCC (MS-
DRG 871) receiving palliative care consults have lower ICU, Operating
Room and Routine Care costs per day after consult.
PC Impact on Average Cost per Day – Septicemia w/MCC
Patients with septicemia or severe sepsis w/o MV 96+ hours w/MCC (MS-
DRG 871) receiving palliative care consults have significantly lower
Inhalation Therapy, ICU, Laboratory, Pharmacy, and Radiology costs after
consult than before consult.
PC Impact on Total Cost – Septicemia w/MCC
Heart Failure & Shock w/CC (MS-DRG 292) patients receiving palliative
care consults cost ~$2,500 less and stay ~1 day less than expired
patients not receiving a PC consult.
PC Impact on Total Cost per Case – Heart Failure & Shock w/CC
**Labels in the bottom view of the dashboard represent the number of days between admission and palliative care consult.
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**Labels in the bottom view of the dashboard represent the number of days between admission and palliative care consult.
Heart Failure & Shock w/MCC (MS-DRG 291) patients receiving palliative
care consults cost ~$3,300 more and stay ~4.3 days longer than expired
patients not receiving a PC consult.
PC Impact on Total Cost per Case – Heart Failure & Shock w/MCC
Heart Failure & Shock w/MCC (MS-DRG 291) patients receiving palliative
care consults have significantly lower ICU, Laboratory, and Pharmacy costs
after consult than before consult.
PC Impact on Total Cost – Heart Failure & Shock w/MCC
30 Day Readmission
Disposition category DRG APR DRG Description Days to
readmit
Type Principal Diagnosis
ECF skilled
191
CARDIAC CATH W CIRC DISORD EXC ISCHEMIC HEART DISEASE 14 ER CHF NOS
Acute rehab45
CVA & PRECEREBRAL OCCLUSION W INFARCT 4 ER Urin tract infection NOS
ECF skilled
42
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS 14 ER Respiratory arrest
Signed off service720
SEPTICEMIA & DISSEMINATED INFECTIONS 5 ER Acute pancreatitis
ECF skilled190
ACUTE MYOCARDIAL INFARCTION 5 ER Atten to gastrostomy
Home with hospice468
OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS 1 ER Adjust dis w anxiety/dep
Home with hospice140
CHRONIC OBSTRUCTIVE PULMONARY DISEASE 2 ER Chr airway obstruct NEC
ECF skilled175
PERCUTANEOUS CARDIOVASCULAR PROCEDURES W/O AMI 6 ER CHF NOS
Home with homecare 0 ER DMII wo cmp nt st uncntr
ECF skilled 194HEART FAILURE 7 IN Acute kidney failure NOS
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Physician Referrals
Physician Name SpecialtyNumber of admissions per
year (2012)
Tarekegne,Mulugeta HOSPITALIST 557 PC has received referrals from 65 different providers.
Harden,Oliver Pierre HOSPITALIST 527 There are only 101 providers who admit
Negash,Yohannes HOSPITALIST 508 more than 6 patients per year to Providence with
Udoh,Moses Eliza HOSPITALIST 459 potential PC appropriate patients.
Vidal,Rachel W HOSPITALIST 425
Zamcho,Anthony MEDICAL CARE 419 The physician who made the most PC referrals
Ansani,Monica Amankwaa HOSPITALIST 391 last year was Dr. Tarekegne, who is the number 1
Bouknight,Daniel Pinckney CARDIOLOGY 370 admitter on this list.
Craft III,Roland Ryhstmas GENERAL SURGERY 360
Hall,Patrick Anthony Xavier CARDIOLOGY 245 Of the top 10 admitters from this list all but 1 have
Robinson,Jerry W INTERNAL MEDICINE 243 made PC refferrals.
Lone,Bashir Ahmad CARDIOLOGY 242
Stuck,William W CARDIOLOGY 236 Of the top 25 admitters from this list all but 2 have
Delphia,Robert Emery CARDIOLOGY 222 made PC referrals.
Foster,Michael Cameron CARDIOLOGY 218
Kendig,Arthur Carlson CARDIOLOGY 218
Gottipaty,Venkateshwar Kotiah CARDIOLOGY 196
Sutton III,John P CARDIAC SURGERY 194
Malanuk,Robert Middleton CARDIOLOGY 191
Phillips III,James William CARDIOLOGY 184
Rhinehart,Rodney G CARDIOLOGY 180
Brown,Brandon Eric CARDIOLOGY 179
Allen,William Baker CARDIAC SURGERY 174
Khoury,Norma Marie CARDIOLOGY 160
Stuck,Leslie Mills INTERNAL MEDICINE 140
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Your Turn . . .
What measures are you collecting?
What metrics do you report to your leadership?
What should you be reporting? And to whom?