California project improves end-of-life care

SAN FRANCISCO – It’s not unusual for nursing home patients to spend the last weeks of their lives in acute care hospitals even if they have made it known that they don’t want to end their days there.

 

A California initiative seeks to address this issue by creating a model for better end-of-life care.

“We live in a culture that really doesn’t want to have to think about this,” said Kathy Glasmire, associate director of the Center for Healthcare Decisions in California and co-author of the project’s brief. “I think even if they feel like they would like to talk about it, they’re not quite sure how. People are always worried that it’s going to be morbid or depressing or will take away hope or will insinuate that the end is sooner than we thought.”

 

The PREPARED project was set up to find out if improvements in advanced care planning would reduce transfers of end-of-life patients from nursing facilities to hospitals and to learn whether this project – or others based on it – could have a financial benefit for hospitals and health systems.

 

The project, tested by the Coalition for Compassionate Care of California, was funded by the California HealthCare Foundation and took place at three hospital systems and 18 nursing homes in the Sacramento area.

 

“I think PREPARE fits a lot with the trends in healthcare policy at the national level to have more coordinated care between settings,” said Judy Citko, executive director of the CCCC.

 

“This really builds on that concept of saying what happens in a nursing home, what happens outside a hospital after discharge, is of relevance to the hospital and that it’s worthwhile to use hospital resources to help manage patients in those settings,” she said. “It takes a community to care for nursing home residents. We shouldn’t be putting patients off in nursing homes isolated.”

 

The results of the project include a reduction in hospitalization rates, an increase in the nursing home as the place of death, medical care consistent with advance directives and improved perceptions of care quality by patients’ family members.

 

The biggest financial benefits of reducing nursing home transfers are “avoiding the increased cost of caring for patients in the acute care setting, avoiding losses commonly incurred for inpatient deaths and avoiding re-admissions that may expose sites to penalties once provisions of the PPACA are implemented.”

 

Having the project provide financial perspective on reducing nursing home transfers is important, said Kathleen Kerr, senior research analyst at the Department of Medicine at the University of California, San Francisco, and a co-author of the brief.

 

“Organizations that might replicate the intervention would need to know ‘Is this an effective means of improving the quality of care?’ and if so, ‘Can we afford to implement it?’” Kerr said.

“It’s important for clinicians and administrators to think about all promising and feasible methods for improving care transitions, especially in vulnerable populations like frail elders who live in nursing homes.”