Sunday, February 21, 2010

Why Organizational Delivery Models Matter to Effective Palliative Care

There are multiple examples of health systems -- President Obama and health policy makers have cited Mayo, Geisinger, Cleveland Clinic, and others as models for health-care reform -- that consistently and reliably achieve similar results: providing good care at low cost, with high patient satisfaction. Bassett Healthcare, serving the Cooperstown, New York region, is among those others. What these systems have in common, we're advised, is that they are integrated systems that employ their physicians, emphasizing patient-centered care, better outcomes, and prudent stewardship of health-care resources, with accountability for results.

We've looked closer into these hospitals and communities to understand better if this model also produces desirable results around late-life care. We've learned previously that Geisinger has seen exemplay results in its late-life care practices. So we took at look through the Dartmouth Medical Atlas at the formerly named Mary Imogene Bassett Hospital, now known simply as Bassett Medical Center. The Hospital's results in the seven DAI Palliative Outcome Measures earned it an exemplary grade. Patients loyal to Bassett were 20% less likely to die in the hospital, spent almost 40% fewer days than state average in a hospital during the last six months of life , and were more likely to have been under hospice/palliative care. Yet perhaps the most telling is that in their final months, 30% fewer patients were seen more than ten physicians during late- life care. You read this correctly, TEN is the benchmark.

Thus, we find that in another community a tightly integrated health system produces desirable outcomes in late-life care. What remains unclear is what attributes of a tightly integrated health system are most responsible for these results. With that knowledge, these attributes might be replicated elsewhere (as in an Accountable Palliative Care Organization).

I'm curious to learn your experiences and thoughts.

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