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Hospitals Opting for Palliative Care

Joe Cantlupe, for HealthLeaders Media, August 6, 2012

"Recognizing these indirect financial effects is critical to ensuring palliative care consultation services continue to expand in hospital settings nationwide," the report said.

By going across service lines, palliative care programs team up their members with other specialists. "Palliative care docs work on a team, and for any individual patient you are highly selective [about] which members of the team you might involve," Quill says.

"Some people might have a spiritual crisis and try to get an experienced chaplain to work with them alongside the medical team. Really, comprehensive care and medical homes are trying to do the same thing," he says, noting that a palliative care team adds expertise in making sure pain, anxiety, shortness of breath, and depression are being addressed.

Over the past three years, palliative care inpatient consultation at the medical center has grown from 250 to 1,000 consultations per year, says Quill. And Rochester has received The Joint Commission's advanced certificate for palliative care, which recognizes hospital inpatient programs that demonstrate excellent patient- and family-centered care and optimize the quality of life for patients with serious illness.

Beyond that, the hospital system has improved palliative care services to the medical home as well as outpatient care, Quill says.

"It's a no-brainer to make palliative care part of the medical home, to provide comprehensive care to people with serious chronic illness. We are good at addressing a lot of symptoms and identifying and a lot of challenges, figuring out how best to use the medical system," Quill says. "Does this treatment work best for me? We help people sort through that. We help them choose the treatment that makes sense for them, given their condition and priorities. We are once removed from people providing high-tech equipment."

Success key No. 3: Children's palliative care
When the Iowa University Health System launched a palliative care program for children three years ago, hospital officials believed it was necessary because there was a "gap of miscommunication" involving kids with severe illnesses and their families, says Janine Petitgout, RN, ARNP, director of pediatric palliative care at the 194-staffed-bed University of Iowa Children's Hospital in Iowa City .

Starting a multidisciplinary program that focused on specific ailments for children seemed the perfect solution.

The Iowa program reflected findings of a study that found a palliative care program for children should acknowledge that their ailments are much different than adults', and the palliative care process might be longer.

Most children in palliative care programs are treated for genetic, congenital, neuromuscular, breathing, and stomach illnesses—much different from an adult palliative care population, which is often dominated by cancer diagnoses. Only about 20% of children had cancer, according to a study in Pediatrics.

"Palliative care teams need a broad understanding of many underlying medical conditions and the ability to skillfully address the complex chronic illnesses, in addition to the challenges of pain and symptom management," according to the Pediatric Palliative Care Research Network and Policy at The Children's Hospital in Philadelphia. The study focused on 515 patients from six hospitals in the United States and Canada in 2008, with follow-up a year later.

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