Facilitating the Palliative Care Discussion: Using the Universal Patient Score to Simplify Clinician-Family Collaboration

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1 Facilitating the Palliative Care Discussion: Using the Universal Patient Score to Simplify Clinician-Family Collaboration

2 Agenda Introduction to the Rothman Index and PeraTrend Jonathan Fullerton, SVP Strategy, PeraHealth The Palliative Care Story and Case Report Duncan Finlay, M.D., CMO, PeraHealth Clinical Use of the RI in Palliative Care Rebecca Gagne-Henderson APRN, ACHPN, PhDc, Palliative Services Program Manager, Yale New Haven Hospital, Saint Raphael Campus Questions and Answers 2

3 The Story: The Rothman Index is Created Turning loss into meaning Florence Rothman: Avoidable death from undetected complication Michael and Steven Rothman: Engineers with expertise in big data analysis and statistics EHR Data: Available but untapped Heuristic modeling techniques create a universal patient score Florence Rothman We didn t want this to happen to someone else s family. Michael Rothman, PhD., Co-Founder 3

4 Rothman Index (RI) is the New Universal Patient Score RI is the evolution of leveraging data to understand patient condition 1952 APGAR Score Newborns Simple, Repeatable Assessment Manual Calculation Criteria: 5 Observations Used Widely Today 1985 APACHE II Adult Patients Admitted to ICU Admission Score Only Criteria: 12 Physiological Measures In Use Today, along with APACHE III and SAPS II All Patients No 1987 Manual Data Entry PEWS Disease Agnostic Automated Calculation MEWS Braden Real Time Adult Patients Manual Scale Integrated with EHR Calculation Common Adult Patients Clinical Criteria: Language 4 Physiological Criteria: Risk of 50+ Measures and Pressure 1 Observation Ulcers Physiological Built on Expert Criteria: Clinical 6 Assessments Opinion Observations Limited Use In Use Lab Today Results Today Includes measures of previous score algorithms Built on Heuristic Modeling Pediatric Population (up to age 18) Manual Calculation Criteria: Originally 20 physiological and observation measurements most hospitals use 4-7 Built on Expert Opinion In Use Today 2010 RI Score 4

5 Visualizing Patient Condition EXISTING EHR DATA PeraTrend Graph Labs Vitals Clinical Assessments 50+ Measures ROTHMAN INDEX Single Numeric Score Rothman Index Opportunities for Earlier Intervention 5

6 Defining Palliative Care Care to relieve symptoms and improve quality of life in patients independent of curative treatment or the lack thereof and should not be confused with hospice care which is limited to patients with a life expectance of 6 months or less who are not engaged in curative treatments. Hospice patients do receive palliative care but all palliative care patients are not hospice patients. 6

7 The Case for Palliative Care Programs Quality of life measures improved Patient and family satisfaction improved Reduced cost of care, both inpatient and outpatient studies Morrison et al reported 11% reduction in cost in patients either discharged or who died in the hospital ** Outpatient palliative care services estimated to reduce overall treatment costs for seriously ill patients by up to 33% per patient*** Meets IHI Triple Aim: better health, improved care, and lower cost* In AMA 2010 report: 60% of all hospitals and 80% of hospitals with > 350 beds had PC programs *The IHI Triple Aim initiative. Cambridge, MA **Health Affairs 30, No 3, 2011 ***Brumley R, et al. J Am Geriatr Soc 2007;55:

8 Using the PeraTrend in Palliative Care Trigger for identifying patients with unmet palliative care needs Basic care by attending physicians, nursing staff, social workers, etc. Palliative Care consultation for more complex cases Resource to share with patients and families in end of life conversations Caveats: 1) Share the trend not the number 2) The number should not be used to give an estimate of % survival 3) The Rothman Index is a tool and should never replace clinical judgment and experience Use in discussions with families regarding discharge planning Share with family members in distant locations 8

9 Shared Decision-making at End-of-life is Aided by Graphical Trending of Illness Severity David B. Bittleman, MD, G. Duncan Finlay, MD, Alan B. Solinger, PhD, BMJ Case Reports, 2014, published online 13 January

10 Clinical Use of Rothman Index in Palliative Care Rebecca Gagne-Henderson APRN, ACHPN, PhDc Palliative Services Program Manager Yale New Haven Hospital, Saint Raphael Campus 509 Bed Community Catholic Hospital Founded by Sisters of Charity 1907 Acquired by Yale New Haven Hospital Beds Potential Palliative Referral Sources 10

11 Palliative Care Screening Criteria 1. RI LOS > 5 days 3. Diagnosis of Pneumonia in ICU 4. COPD/Renal Disease/CHF If over 80 years, RI < 40 and Full Code included 11

12 Quality Initiative Questions What is the average daily census of patients with a Rothman Index (RI) Score of 40? What is the daily average number of patients with palliative needs on St. Raphael s Campus? What is the daily average number of new potential referrals to Palliative Care when using the RI Score? 12

13 Current Impact of using RI as Palliative Care Consult Date Census RI 40 Palliative Care Needs 2/ % 28 13% N/A New Pall. Care Needs Today 2/ % 32 15% 3 37% 2/ % 32 15% 7 58% 2/ % 35 17% 8 88% 2/ % 28 13% 4 30% 2/ % 35 16% 5 38% 2/ % 36 16% 6 36% 2/ % 29 13% 4 57% 2/ % 38 17% 7 78% 13

14 Use Case: Readmission 11 Days Post-Discharge Admit 1 Admit 2 11 days post DC Discharge Expired 14

15 Use Case 2: Consult on Patient Admit Consult Expired 15

16 Use Case 3: Multiple Admissions Expired 16

17 Upcoming Quality Initiative Project Retrospective Prospective < 40 RI < 40 > 5 day LOS > 5 day LOS No Consult Consult Outcomes 30-day readmit Hospice CMO LOS Cost Outcomes 30-day readmit Hospice CMO LOS Cost 17

18 New Directions in Palliative Care Saturday, April 12 th, :00 am 5:30 pm This conference will explore cultural and ethical aspects of end-of-life care, innovative systems solutions, and resolutions to difficult decision making. Nurses, physicians and residents, PAs, social workers, chaplains, and healthcare administrators are encouraged to attend. Continuing education credits will be provided. Keynote Speaker: Timothy M. Quill, MD Navigating the Shoals of Palliative Care: Partnership & Non-Abandonment Professor of Medicine, Psychiatry, and Medical Humanities University of Rochester School of Medicine Director, Center for Ethics, Humanities and Palliative Care Plenary Speaker: Angelo Volandes, MD, MPH Advanced Care Planning Using Video Tools Internist and Researcher, Harvard Medical School and Massachusetts General Hospital; Co-Founder, Plenary Speaker: Christina Puchalski, MD, MS Spirituality: An Essential Part of Palliative Care Professor of Medicine and Health Sciences, George Washington University; Founder and Director The George Washington University Institute for Spirituality and Health CONNECTICUT COALITION TO IMPROVE END-OF-LIFE CARE For more information, contact Lori Bruce at Yale School of Nursing is an Approved Provider of Continuing Nursing Education by the CT Nurses Association, An accredited Approver by the American Nurses Credentialing Center s Commission on Accreditation. Promote compassionate care for all people touched by life-limiting conditions

19 Questions and Answers Visit Us at HIMSS14! Booth #5568 More Questions? Jonathan Fullerton, SVP, Strategy G Duncan Finlay, M.D., Chief Medical Officer Publications and General Information 19

20 20 THANK YOU!

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