RESUMO
BACKGROUND: Home-based palliative care fills a critical gap between acute care (during crises) and hospice care for seriously ill patients. As of 2018, home-based palliative care capacity in the United States has not scaled to meet patient needs. OBJECTIVES: The Center to Advance Palliative Care (CAPC) conducted a needs assessment to catalog and analyze barriers to growth in the field of home-based palliative care. METHODS: Home-based palliative care program leaders were surveyed and interviewed to elicit information about program characteristics, barriers to meeting national palliative care quality standards or to program growth, and essential elements of program sustainability. RESULTS: Home-based palliative care program leaders cited their major challenges as being: a lack of clarity on the applicability of national standards to home-based programs, a lack of sustainable financing methods for home-based palliative care, and lack of awareness of existing support resources for program design and leadership development. CONCLUSIONS: Home-based palliative care programs will benefit from improved professional awareness of national quality standards and existing technical assistance. New prospects for alternative payment models that allow for sustainable interdisciplinary home-based care represent a promising opportunity for the field.
Assuntos
Serviços de Assistência Domiciliar/estatística & dados numéricos , Serviços de Assistência Domiciliar/normas , Cuidados Paliativos na Terminalidade da Vida/normas , Cuidados Paliativos/estatística & dados numéricos , Cuidados Paliativos/normas , Qualidade da Assistência à Saúde/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários , Estados UnidosRESUMO
Early, integrated palliative care has been shown to improve quality of life and reduce utilization in both inpatient and outpatient settings. As health systems shift to risk-based payment structures, palliative care will play an increasing role in improving value of care outside of the hospital. Based on successful models of community-based palliative care, we identify six principles - interdisciplinary team-based care; 24/7 access and responsiveness; concurrent palliative care with disease-directed treatment; targeting services to high-risk patients; integrated medical and social supports; and caregiver support - that are widely implemented because of their impact on improving value for seriously ill individuals.
