Dissemination of a successful dementia care program: Lessons to facilitate spread of innovations.

BACKGROUND: Despite the effectiveness of innovations to improve the care of persons with dementia, there has been limited diffusion of these into widespread clinical practice. We aimed to identify common barriers and address them directly in the initial phase of dissemination of a successful dementia care program. METHODS: Description of and early experience with a dissemination strategy of the UCLA Alzheimer's and Dementia Care Program to health care systems nationwide. We measured site-identified goals for the program and indicators of success, number of adopting sites, and participants in their programs. RESULTS: From January 2019 to December 2021, 80 sites expressed interest in adopting the program, 14 (18%) sites adopted it, and 10 of these sites have begun caring for patients. Another 4 sites have implemented the program as part of a randomized clinical trial. To date, over 1690 persons living with dementia and their caregivers have received Alzheimer's and Dementia Care (ADC) care at 14 adopting sites. Key lessons from the early dissemination efforts include the importance of identifying a strong product champion at the adopting site, creating a business case for adoption, training of clinical staff and adapting the model to fit local cultures and workflow, as well as recognizing the likely long length of time needed for the decision to adopt and implementation process. CONCLUSIONS: Despite many obstacles to dissemination, with local champions and technical assistance, successful innovations in dementia care can be implemented in diverse health systems. The ability to adopt sites to bring the program to full scale and achieve comparable outcomes to the original program remains to be determined.

Designing Effective Payer Models to Improve Serious Illness Care.

Improving care for patients with serious illness requires building reliable supports across settings and over time. Consistency of approach by payers can simplify and accelerate provider-based solutions. Early attention to predictable challenges and shared principles can help guide design to more sustainable solutions.

Impact of Staffing on Access to Palliative Care in U.S. Hospitals.

BACKGROUND: Over the past decade over two-thirds of U.S. hospitals have established palliative care programs. National data on palliative care program staffing and its association with operational outcomes are limited. OBJECTIVE: The objective of this report is to examine the impact of palliative care program staffing on access to palliative care in U.S. hospitals. METHODS: Data from the National Palliative Care Registry™ for 2014 were used to calculate staffing levels, palliative care service penetration, and time to initial palliative care consultation for 398 palliative care programs operating across 482 U.S. hospitals. RESULTS: Hospital-based palliative care programs reported an average service penetration of 4.4%. Higher staffing levels were associated with higher service penetration; higher service penetration was associated with shorter time to initial palliative care consultation. DISCUSSION: This report demonstrates that operational effectiveness, as measured by staffing and palliative care service penetration, is associated with shorter time to palliative care consultation.

Hospital mortality rates: how is palliative care taken into account?

CONTEXT: Using mortality rates to measure hospital quality presumes that hospital deaths are medical failures. To be a fair measure of hospital quality, hospital mortality measures must take patient-level factors, such as goals of care, into account. OBJECTIVES: To answer questions about how hospital mortality rates are computed and how the involvement of hospice or palliative care (PC) are recognized and handled. METHODS: We analyzed the methods of four entities: Centers for Medicare & Medicaid Services "Hospital Compare;" U.S. News & World Report "Best Hospitals;" Thomson-Reuters "100 TopHospitals;" and HealthGrades. RESULTS: All entities reviewed rely on Medicare data, compute risk-adjusted mortality rates, and use "all-cause" mortality. They vary considerably in their recognition and handling of cases that involved hospice care or PC. One entity excludes cases with prior hospice care and another excludes those discharged to hospice at the end of the index hospitalization. Two entities exclude some or all cases that were coded with the V66.7 "Palliative Care Encounter" International Classification of Disease, Ninth Revision, Clinical Modification diagnosis code. CONCLUSION: Proliferation of, and variability among, hospital mortality measures creates a challenge for hospital administrators. PC and hospice leaders need to educate themselves and their hospital administrators about the extent to which these mortality rates take end-of-life care into account. At the national level, PC and hospice leaders should take advantage of opportunities to engage these mortality raters in conversation about possible changes in their methods and to conduct further research on this topic.

Center to Advance Palliative Care palliative care consultation service metrics: consensus recommendations.

The need to standardize the prospective collection and analysis of data has been a cornerstone of education and technical assistance provided by the Center to Advance Palliative Care (CAPC). Data analysis is vital for strategic planning, quality improvement, and demonstration of program impact to hospital administrators, private funders, and policymakers. To develop a set of core measures, CAPC convened a consensus panel in 2008 to focus on the topic of operational metrics for consultation services. Operational metrics, as distinct from clinical, customer and financial metrics, describe the characteristics of patients seen on the consultation service, such as age, disease, location, referring service and disposition. The panel arrived at 12 metric domains, all but one of which can be used for either internal programmatic use or for external comparisons of service characteristics/impact between different hospitals. In an effort to ensure access to reliably high-quality palliative care data throughout the nation, hospital palliative care consultation teams are encouraged to collect and report outcomes for each of the twelve metric domains described here.