Improving access to palliative care through an innovative quality improvement initiative: an opportunity for pay-for-performance.
BACKGROUND
Improving access to palliative care is an important priority for hospitals as they strive to provide the best care and quality of life for their patients. Even in hospitals with longstanding palliative care programs, only a small proportion of patients with life-threatening illnesses receive palliative care services. Our two well-established palliative care programs in large academic hospitals used an innovative quality improvement initiative to broaden access to palliative care services, particularly to noncancer patients.


METHODS
The initiative utilized a combination of electronic and manual screening of medical records as well as intensive outreach efforts to identify two cohorts of patients with life-threatening illnesses who, according to University HealthSystems Consortium (UHC) benchmarking criteria, would likely benefit from palliative care consultation. Given the differing cultures and structure of the two institutions, each service developed a unique protocol for identifying and consulting on suitable patients.


RESULTS
Consultation rates in the target populations tripled following the initiative: from 16% to 46% at one hospital and from 15% to 48% at the other. Although two different screening and identification processes were developed, both successfully increased palliative care consultations in the target cohorts.


CONCLUSIONS
Quality improvement strategies that incorporate pay-for-performance incentives can be used effectively to expand palliative care services to underserved populations.
Department of Psychosocial Oncology and Palliative Care, Dana Farber Institute, Boston, MA, USA.
Rachelle E
RE
Bernacki
Danielle N
DN
Ko
Philip
P
Higgins
Sandra N
SN
Whitlock
Amelia
A
Cullinan
Robin
R
Wilson
Vicki
V
Jackson
Constance
C
Dahlin
Janet
J
Abrahm
Elizabeth
E
Mort
Kenneth N
KN
Scheer
Susan
S
Block
J Andrew
JA
Billings
D019985:Benchmarking; D006297:Health Services Accessibility; D006801:Humans; D008404:Massachusetts; D010166:Palliative Care; D018579:Patient Selection; D010816:Physician Incentive Plans; D058996:Quality Improvement; D012017:Referral and Consultation