Thursday, March 17, 2011

30/30/30 Campaign to Improve Late-Life Care

A Palliative Care Summit was recently convened in Philadelphia by the School of Population Health at Thomas Jefferson University. It was described as the “First National” and the “Leading Forum on Palliative and End-of-Life Care”.

An impressive array of speakers over the two days. Diane Meier,MD, Sean Morrison, MD, Don Schumacher, David Wennberg, MD, Christine Richie, MD, Terri Maxwell, PhD,APRN, James Cleary, MD.,Todd Hultman,PhD,APRN to name but a few. A roster of thought leaders in the field. Compelling cases were made during the presentations on why hospice and palliative care (is/are?) the solution to many of the health care industry’s woes. Meanwhile, just next door, other industry thought leaders were offering compelling cases on why “medical homes” or ‘expanded chronic care models” or “mobile technology” were desirable solutions for transformation of the health care system.

In other words, competing, or one might say, conflicting visions. These competing/conflicting visions exist across specialties, and within them. Dr. Morrison addressed this issue when he stated that the public and professionals are confused by references to hospice and palliative care , as if these were two distinct fields or sectors.

While my training is as a health executive, I’ve spent much of my professional career advancing the work of palliative care/hospice professionals and organizations. So I pay closer attention to the hospice/palliative care field, and how it may best fit into the larger health care system. And as Dr. Morrison stated directly, and others commented more indirectly, while progress has been made over the past 15 years, the institutional culture of dying in the US has not dramatically changed. I refer to palliative care as one parts accomplishment for every three parts of potential. Yes, we have a long way to go, indeed.

At the end of the Summit, I was left with a nagging question: If hospice and palliative care are such an obvious solution, then why hasn’t the “art” and “science” of hospice and palliative care spread more quickly and widely than it has? No simple answers to be sure. Yes, many of the speakers offered calls (some powerful) to action. Yet calls for action have been sounded for the past 15 years, with some, but most would argue, insufficient progress. Why? The promise of palliative care to improve late-life care has been stymied by a highly fragmented field of hospice and palliative care where stakeholders are perpetually “staking” out their ground.

Some suggestions for the Second National Palliative Care Summit. Let’s have discussions around:

  • How nursing AND medicine can best collaborate to improve access to palliative care in all settings across the community.

  • What NEW organizational models might best bring together key stakeholders in late-life care within a community?

  • What can be learned from communities whose late-life care practices make them exemplars?
Finally, we need a unifying campaign to improve late-life care in the US. Here’s a suggestion. The 30/30/30 Campaign. A national campaign carried out locally/regionally.

Something like the following:

  • No more than 30% of deaths occur in hospitals.
  • At least 30% of deaths in hospital are consulted by palliative care specialists.
  • No more than 30% of patients who die will be enrolled in hospice for 10 days or less.
Your comments, ideas, feedback are, as usual, invited.


Jason Tenzer said...

Tim, great synopsis of some very pressing issues. Having worked for/with Drs. Meier and Morrison when I was the Administrator for Mt. Sinai's Palliative Care Program, I know very well how hard they have fought for the cause. In fact, like you, it has grown near and dear to my heart and I continue to this day to keep up with the issues regarding hospice and palliative care. Thanks for posting this piece and sharing via LinkedIn.

Robert A. Fried, M.D. said...

I think this is a great slogan and a great goal to which we should aspire. Changing the culture surrounding late-life care will be difficult, as the "death panel" madness so vividly illustrates. The health care system also must do its part.

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