Risk Assessment-Focused Interdisciplinary Outpatient Palliative Care Consultation for Elderly Veterans
Keywords:
Risk stratification, Geriatric care, Outpatient palliative care consultationAbstract
Context
The Centers for medicare and medicaid services (CMS) and the Veterans Administration quality improvement objectives encourage completion of advance directives and palliative care consultation to enhance patient-centered care and to promote patient autonomy. The prevalence of advance care planning documents in the electronic health record (EHR) and outpatient palliative care consultation is low and strategies to improve outpatient advance care planning are needed. The aim of this feasibility project was to risk stratify the older Tennessee Valley Healthcare System (TVHS) population, utilizing operations data, to target primary palliative care consultation and completion of advance care planning documents.
Methods
We compared immediate outpatient palliative care consultation outcomes in two populations: Group 1: high-risk patients identi-fied using a clinical risk calculator, the clinical assessment of need (CAN) compared to Group 2: consecutive patients presenting to a geriatric clinic.
Results
The patient population identified systematically by high-risk CAN score for advance care planning (Group 1), N=52, increased palliative care consultation prevalence to 35%. The prevalence of advance care planning documents in the EHR remained 30% for this population. High-risk patients were more often referred for community-based services (29% versus 12%) and received more hospice referrals (8% versus 4%) compared to a sample of consecutive patients presenting to a geriatric clinic (Group 2), N=26.
Conclusion
A systematic approach to identifying high-risk patients appears to target a population with more needs compared to a sample of consecutive elderly outpatients presenting in the outpatient department. A clinically derived risk calculator can help identify high-risk patients appropriate for focused care services, such as geriatric specialty care, home and community based services, and advance care planning.
