Dying in America Improving Quality and Honoring Individual Preferences Near the End of Life (2015) / Chapter Skim
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Appendix B: Recommendations of the Institute of Medicine's Reports *Approaching Death* (1997) and *When Children Die* (2003): Progress and Significant Remaining Gaps
Appendix B: Recommendations of the Institute of Medicine's Reports *Approaching Death* (1997) and *When Children Die* (2003): Progress and Significant Remaining Gaps
Pages 407-442
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From page 407... ...
. In 2011, an estimated 1.65 million patients received hospice services; a million of them died under hospice care during that year (NHPCO, 2012a)
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in 1999, is a national resource providing health care professionals with tools, training, and technical assistance to increase access to quality palliative care services in hospitals and other health settings. It also works to improve relevant payment and regulatory policies.
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1997 Recommendation 2: Physicians, nurses, social workers, and other health professionals must commit themselves to improving care for dying patients and to using existing knowledge effectively to prevent and relieve pain and other symptoms. • The number of palliative care teams within hospital settings has increased by approximately 148 percent, from more than 600 in 2000 to more than 1,600 in 2012 (CAPC, 2012)
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Quality and Practice Standards Task Force and the Hospice and Palliative Nurses Association (HPNA) Research Advisory Group, seeks to identify a set of basic, advanced, and aspirational evidence-based performance measures that are relevant to all hospice and pallia tive care programs (American Academy of Hospice and Palliative Medicine, undated-a,b,c)
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in (b) evelop better tools and strategies for improving the quality of care d and holding health care organizations accountable for care at the end of life; • NHPCO now reports data related to patient outcomes and mea sures; family evaluation of hospice care, palliative care, and be reavement services; and team attitudes and relationships (NHPCO, undated-a)
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From page 412... ...
.5 • The ACA further calls for a concurrent care demonstration pro gram to test whether concurrent care would save money while improving Medicare patients' quality of life.6 In March 2014, CMS launched the Medicare Care Choices Model, which will allow se lected Medicare-certified hospices to provide palliative care services to patients with certain serious advanced illnesses who meet the Medicare Hospice Benefit eligibility criteria but are still receiving curative care (CMS, 2014)
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. • The ACA alters the Medicare hospice rate formula, wage index, and payment rate through – introduction of a productivity adjustment factor, which will lower annual hospice payments by an additional 11.8 percent over the next decade (CMS, 2013c; Hospice Action Network, 2013)
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The report card is currently supported by the American Cancer Society, the American Cancer Society Cancer Action Network, and the LIVESTRONG Foundation (Pain & Policy Studies Group, 2014b)
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• AAHPM, which began with 250 founding member physicians in 1988, had nearly 5,000 members as of mid-2013 (American Acad emy of Hospice and Palliative Medicine, undated-d)
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. • Hospice and palliative medicine content is relatively lacking in many board certification examinations in specialties in which basic palliative care is especially relevant, accounting for only 2 percent of the board certification exam in oncology (ABIM, 2013a)
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• In 2006, the American Board of Medical Specialties approved hospice and palliative medicine as a medical subspecialty of 10 participating boards, and the Accreditation Council for Graduate Medical Education voted to accredit fellowship training programs in this subspecialty. By 2009, CMS had approved palliative medi cine as a subspecialty (CMS, 2009b)
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. Remaining gaps: • An estimated 4,487 hospice and 10,810 palliative care physi cian FTEs are needed to staff the current number of hospice- and hospital-based palliative care programs at appropriate levels (Lupu and AAHPM Workforce Task Force, 2010)
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The cen ter's partner organization, the Center to Advance Palliative Care, enables rapid translation of these research findings into clinical practice. • The Palliative Care Research Cooperative Group (PCRC)
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• Since 1997, numerous public education efforts focused on issues of advance care planning and palliative care have been launched. These campaigns have had varying sponsorship, and some have been coalition efforts.
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. • Two of the National Rural Health Association's three Technical Assistance Project community-based teams -- in Franklin, North Carolina, and Ruleville, Mississippi -- focused their efforts on de veloping provider and community education and outreach plans around advance directives (Stratis Health, 2009)
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• NHPCO developed Standards of Practice for Pediatric Palliative Care and Hospice (NHPCO, 2009) , which identifies four diagnos tic categories of patients who should be offered palliative care and/ or hospice services.
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. • In 2010, the Association of Pediatric Hematology/Oncology Nurses, in partnership with the Children's Oncology Group Nurs ing Discipline, published Pediatric Oncology Palliative and End of-life Care Resource, which provides information about palliative care to nurses caring for critically and terminally ill children with cancer (Ethier et al., 2010)
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There is no life expectancy requirement for participation in the program, which provides services for pain and symptom management; case manage ment; counseling and psychosocial support; respite care; comple mentary therapies; spiritual care; and bereavement services for family, caregivers, siblings, and others. • NHPCO has developed a number of tools to support hospice and palliative medicine health care teams, although these resources do not include content specific to pediatric populations (NHPCO, undated-c)
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From page 425... ...
– The Rural Palliative Care Network at Vermont Children's Hos pital expands Fletcher Allen Health Care's Palliative Medicine Service and allows the hospital's clinicians to share their pallia tive care expertise with the region's clinicians and community hospital staff. The network's services include telemedicine con sultations, a palliative medicine hotline, a palliative medicine mentorship program, site visits, and weekly case conferences (Fletcher Allen Health Care, 2014)
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. • A 2011 study found that 24 of 28 surveyed pediatric palliative care programs (86 percent)
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Children may be enrolled simultane ously in programs that provide supplemental services not covered by Medicaid and CHIP, such as specialized home health care, case management, respite care, and family support services (NHPCO, 2010) .13 • A number of states have obtained waivers from CMS rules to establish or augment pediatric palliative services.
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. 2003 Recommendation 10: To provide instruction and experiences appropriate for all health care professionals who care for children, experts in general and specialty fields of pediatric health care and education should collaborate with experts in adult and pediatric palliative care and education to develop and implement [model curricula, residency program requirements, pediatric palliative care fellowships, introductory and advanced continuing education programs, and strategies to evaluate techniques and tools for educating health professionals in palliative care, end-of-life, and bereavement care]
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From page 429... ...
. • NBCHPN® administers the following hospice and palliative pe diatric nurse examinations accredited by the American Board of Nursing Specialties through 2015: – Advanced Certified Hospice and Palliative Nurse, – Certified Hospice and Palliative Nurse, – Certified Hospice and Palliative Licensed Nurse, – Certified Hospice and Palliative Nursing Assistant, – Certified Hospice and Palliative Care Administrator, – Nurse Certified in Perinatal Loss Care, and – Certified Hospice and Palliative Pediatric Nurse (NBCHPN®, 2014)
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. 2003 Recommendation 12: Units of the National Institutes of Health and other organizations that fund pediatric oncology, neonatal, and similar clinical and research centers or networks should define priorities for research in pediatric palliative, end-of-life, and bereavement care.
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. – 2013, NPCRC established the Lord Pediatric Palliative Care In Career Development Awards with the support of the Lord Foundation (NPCRC, 2013)
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2010. A strategy to advance the evidence base in palliative medicine: Formation of a palliative care research cooperative group.
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. American Academy of Hospice and Palliative Medicine.
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2011. Massachusetts' Pediatric Palliative Care Network: Suc cessful implementation of a novel state-funded pediatric palliative care program.
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2013c. Medicare program; FY 2014 hospice wage index and payment rate update; hospice quality reporting requirements; and updates on payment reform; final rule.
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2013. Medicare program; FY2014 hospice wage index and payment rate update; hospice quality reporting requirements; and updates on payment reform.
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2014. Pediatric palliative care network.
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2004. National Consensus Project for Quality Palliative Care: Clinical practice guidelines for quality palliative care, executive summary.
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Palliative Medicine 13:37-44. PCORI (Patient-Centered Outcomes Research Institute)
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The PEACE project: Identification of quality measures for hospice and palliative care. Journal of Palliative Medicine 13(12)
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2008. How I wish to be remembered: The use of an advance care planning document in adolescent and young adult populations. Journal of Palliative Medicine 11(10)
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