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The Case for Palliative Care

Molly Rowe, for HealthLeaders Magazine, June 13, 2008
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As the population ages and patients get sicker, palliative medicine is increasingly recognized as a way to both improve patient care and save valuable hospital resources.

Patient X is a 59-year-old woman with kidney disease. Thirty years ago, she'd likely be dead. But today, thanks to medical advances and high-tech treatment, she's had nine lives. For most of those lives, she's been in and out of the hospital, often being saved from the brink of death, only to go home for a week before returning for another round of aggressive treatments. Her care is further complicated by a staph infection that won't go away. The patient is in constant pain, her family is increasingly unhappy with her caregivers, her clinicians are tapped out, and healthcare costs are soaring.

The case of Patient X is an all-too-typical story of how complex medical cases can play out. Enter palliative medicine, an increasingly popular approach to treating seriously ill patients. Although not new (palliative care has been around for more than 30 years), the number of medical centers offering palliative care has more than doubled since 2000, according to Diane E. Meier, MD, director of the Center to Advance Palliative Care, an national organization based at New York City's Mount Sinai School of Medicine. Many organizations have discovered that a palliative care program can help both patients and the hospital's bottom line.

Dying well
Palliative care goes beyond the typical "diagnose and treat" method of medicine to focus on patients' comfort and quality of life as they undergo rigorous treatment for conditions like cancer or chronic heart failure. The palliative care team, comprising a nurse, doctor, social worker, chaplain, and other therapists, focuses on pain and symptom management, ensures good communication between patient, family, and doctors and coordinates care between the hospital and other healthcare settings (home, nursing homes, hospices, etc.), Meier explains.

Although palliative care isn't reserved for terminally ill patients, patients usually have a life-threatening disease. If a patient is dying, palliative care's goal is to improve the dying process, says Ira Byock, MD, director of palliative medicine at Dartmouth-Hitchcock Medical Center, a 375-licensed-bed hospital in Lebanon, NH. "If a medical facility cares for people who are seriously ill and go on to die, I think you'll find that the public is going to be expecting and demanding that there be some type of palliative care program," Byock says.

The business case
Patients who receive palliative care are usually among a hospital's sickest and most complex. Once discharged, they are at the highest risk for readmittance within 30 days. While these patients typically represent only 10% of the inpatient population, Meier says, they account for far more than 10% of a hospital's resources. Palliative care services can help hospitals free up bed space by facilitating transfer of care from an intensive care bed to a general hospital services bed or out of the hospital altogether.

Moving dying patients out of the hospital means fewer inpatient deaths, which ultimately reduces a hospital's mortality rates, says Britain Nicholson, MD, senior vice president and chief medical officer at Massachusetts General Hospital, a 789-staffed-bed teaching hospital in Boston. Nicholson is quick to point out that palliative care isn't about providing fewer services; it's about providing better services. Palliative care teams don't force people to stay out of the hospital; they just ensure that patients are comfortable—and that's often in their own homes, Nicholson explains.

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