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Demonstration of a sustainable community-based model of care across the palliative care continuum.

Publication ,  Journal Article
Bull, JH; Whitten, E; Morris, J; Hooper, RN; Wheeler, JL; Kamal, A; Abernethy, AP
Published in: J Pain Symptom Manage
December 2012

CONTEXT: In the U.S., the number of hospital-based palliative care programs has increased rapidly, but availability of outpatient palliative care remains limited. Multiple barriers impede the financial viability of these programs. Four Seasons, a nonprofit organization in western North Carolina, delivers a full spectrum of palliative care in hospitals, nursing homes, assisted living facilities, patients' homes, and outpatient clinics; its catchment area encompasses approximately 350,000 people. Initially focused on hospice care, Four Seasons added its palliative care program in 2003. Before the inquiry described herein, financial losses from outpatient palliative care (2003-2008) were escalating. OBJECTIVES: We explored organizational and financial barriers to sustainability of palliative care, so as to 1) identify reasons for financial losses; 2) devise and implement solutions; and 3) develop a sustainable model for palliative care delivery across settings, including the outpatient setting. METHODS: In 2008, Four Seasons's palliative care program served 305 patients per day (average) with 10.5 providers (physicians, nurse practitioners, and physician assistants); financial losses approached $400,000 per year. We used Quality Assessment and Performance Improvement cycles to identify challenges to and inefficiencies in service provision, developed targeted strategies for overcoming identified barriers to cost-efficiency, instituted these measures, and tracked results. RESULTS: In 2011, Four Seasons served 620 palliative care patients per day (average) with 14 providers; financial losses decreased by 40%. CONCLUSION: With health care reform promoting integration of care across settings, outpatient palliative care will gain importance in the health care continuum. Process changes can help reduce financial losses that currently impede outpatient palliative care programs.

Duke Scholars

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Published In

J Pain Symptom Manage

DOI

EISSN

1873-6513

Publication Date

December 2012

Volume

44

Issue

6

Start / End Page

797 / 809

Location

United States

Related Subject Headings

  • Palliative Care
  • Organizational Objectives
  • Organizational Culture
  • North Carolina
  • Models, Organizational
  • Models, Economic
  • Health Care Costs
  • Cost Savings
  • Community Health Services
  • Anesthesiology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bull, J. H., Whitten, E., Morris, J., Hooper, R. N., Wheeler, J. L., Kamal, A., & Abernethy, A. P. (2012). Demonstration of a sustainable community-based model of care across the palliative care continuum. J Pain Symptom Manage, 44(6), 797–809. https://doi.org/10.1016/j.jpainsymman.2011.12.278
Bull, Janet H., Elizabeth Whitten, John Morris, Richelle Nugent Hooper, Jane L. Wheeler, Arif Kamal, and Amy P. Abernethy. “Demonstration of a sustainable community-based model of care across the palliative care continuum.J Pain Symptom Manage 44, no. 6 (December 2012): 797–809. https://doi.org/10.1016/j.jpainsymman.2011.12.278.
Bull JH, Whitten E, Morris J, Hooper RN, Wheeler JL, Kamal A, et al. Demonstration of a sustainable community-based model of care across the palliative care continuum. J Pain Symptom Manage. 2012 Dec;44(6):797–809.
Bull, Janet H., et al. “Demonstration of a sustainable community-based model of care across the palliative care continuum.J Pain Symptom Manage, vol. 44, no. 6, Dec. 2012, pp. 797–809. Pubmed, doi:10.1016/j.jpainsymman.2011.12.278.
Bull JH, Whitten E, Morris J, Hooper RN, Wheeler JL, Kamal A, Abernethy AP. Demonstration of a sustainable community-based model of care across the palliative care continuum. J Pain Symptom Manage. 2012 Dec;44(6):797–809.
Journal cover image

Published In

J Pain Symptom Manage

DOI

EISSN

1873-6513

Publication Date

December 2012

Volume

44

Issue

6

Start / End Page

797 / 809

Location

United States

Related Subject Headings

  • Palliative Care
  • Organizational Objectives
  • Organizational Culture
  • North Carolina
  • Models, Organizational
  • Models, Economic
  • Health Care Costs
  • Cost Savings
  • Community Health Services
  • Anesthesiology