Optimizing Specialty Palliative Care: Five Key Strategic Initiatives

Abstracts from the Kaiser Permanente2018 National Quality Conference


Dana Benton, RN, MS, CNS; Melissa Stern, MBA


From Northern California

Background: At Kaiser Permanente Northern California (KPNC), there is an identified need for expanding services upstream of hospitalizations to increase consistency in practice and to provide referring practitioners and patients with a clear understanding of what to expect from specialty palliative care (SPC) consults. We have implemented five large-scale initiatives to address these gaps and support our vision that all patients with serious illness and their families live as well and as fully as possible.
Methods: 2017 quality goals: Long-term care plan (LCP) or palliative care (PC) before death: Percentage of adult members with a LCP or PC before death; seven-day-a-week staffing: Percentage of Saturdays and Sundays with PC consult documentation. Optimizing specialty palliative care in KPNC and addressing the above gaps, KPNC rolled out the following five initiatives: the development of a prospective patient registry, a transdisciplinary staffing model, a uniform approach to assessment and documentation, customized training for all SPC clinicians, and a comprehensive measurement strategy.
Results: Prospective patient registry: Monthly medical record number (MRN) level reporting and identifying more than 11,000 KPNC members in need of specialty palliative care. Transdisciplinary staffing model: The staffing model aims to ensure both access and care consistency for all patients who would benefit from SPC in both inpatient and outpatient settings. Standardized assessment tools and documentation: Three tools are used as part of a comprehensive assessment for every consultation. Customized training for SPC clinicians: Trained more than 300 nurses, social workers, and chaplains. Comprehensive measurement strategy: Measuring the impact of these initiatives included the production of monthly dashboards and leadership reports.
Discussion: These five initiatives set a standard for what every patient across KP receives as part of initial and follow-up SPC consultation and allows us to be deliberate in our measurement strategy to drive optimization in SPC. With monthly data for 2017 providing baseline trends, we have set targets for 2018 for registry penetration and will be considering process measures to assure continued provision of a transdisciplinary staffing model and use of assessment tools.

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