A commentary on how palliative care programs and palliative medicine physicians can play a role in the improvement of advanced illness management in the US
Sunday, May 4, 2008
Advanced Palliative Care Organizations -An Organizational Model to Distribute Palliative Care
Hospices are especially adept at managing patients close to the end-of-life. My study suggests there are two reasons - because the number of such patients that hospices serve is so large (more than 50% for many hospices) AND because the most challenging patients (clinically and financially) are those with lengths of stay of 10 days or less. Several research studies have found that the most costly periods of care, under the hospice benefit, are the FIRST five days of enrollment on the hospice benefit and the LAST five days of life. So it's natural to expect that hospices will become proficient in managing "short-stay" patients.Currently, palliative care in this nation is organized, and thus delivered, around the hospice benefit. No question, greater accessibility to better end-of-life care has resulted since Medicare introduced the hospice benefit. I believe most of us would agree,however, that palliative care applies to many more patient populations than those fast approaching end-of-life. How can we best assure that chronically ill populations benefit from palliative care? By reorganizing, around Advanced Palliative Care Organizations, how health care is provided to those with life-limiting diseases.