Risk Assessment-Focused Interdisciplinary Outpatient Palliative Care Consultation for Elderly Veterans.
The Centers for medicare and medicaid services and the Veterans
Administration quality improvement objectives encourage completion of advance directives and palliative care consultation to enhance patient-centered care and to promote patient autonomy.
The prevalence of advance care planning documents in the
electronic health record and outpatient palliative care consultation is low and strategies to improve outpatient advance care planning are needed. The aim of this feasibility project
was to risk stratify the older Tennessee Valley Healthcare System population, utilizing operations data, to target primary palliative care consultation and completion of advance care planning documents.
We compared immediate outpatient palliative care consultation outcomes in two populations: Group 1: high-risk patients identified using a clinical risk calculator, the clinical assessment of need compared to Group 2: consecutive patients presenting to a geriatric clinic.
The patient population identified systematically by high-risk
CAN score for advance care planning (Group 1), N=52, increased palliative care consultation prevalence to 35%. The prevalence of advance care planning documents in the EHR remained 30% for
this population. High-risk patients were more often referred for
community-based services (29% versus 12%) and received more hospice referrals (8% versus 4%) compared to a sample of consecutive patients presenting to a geriatric clinic (Group 2), N=26.
A systematic approach to identifying high-risk patients appears to target a population with more needs compared to a sample of consecutive elderly outpatients presenting in the outpatient department. A clinically derived risk calculator can help identify high-risk patients appropriate for
focused care services, such as geriatric specialty care, home and community based services, and
advance care planning.
Palliat Med Hosp Care Open J. 2019; 5(1): 1-3. doi: 10.17140/PMHCOJ-5-130