Dying in America is the name of a report recently released by The Institute of Medicine. The focus of the study was on improving access to and quality of end-of-life care for medical patients receiving treatment in the United States.
Lack of Palliative Care
Experts determined that the United States suffers a lack of specialists in palliative care. Additionally, it was discovered that medical clinicians currently in health care lack the appropriate knowledge and skills to assist patients facing end-of-life concerns. The experts analyzing the current state of palliative care access provided several recommendations in areas such as care delivery, communication with the dying patient and with their families,professional palliative care education, patient assistance and engagement and provider payment. The analysis found failures within the healthcare system and suggested solutions that include input from patients, healthcare providers and insurance representatives.
Recent Research and Findings
In February, The Lancet released a study including more than 450 patients suffering advanced lung, breast, and gynecologic cancers. All patients included in the study had a prognosis of longer than six months to live. Clinical care for all patients was the same, but approximately half of the members of the study received early intervention consultations. These consultations include a comprehensive connection with a palliative care team, and regular check-ins by telephone. Before beginning the study, patients assigned to palliative care teams began the study in poorer health than those in the control group. After three months, those same patients in the intervention group showed improvements in their quality of life. After four months, patients with palliative care teams showed clinical improvements as well. Patients receiving dedicated palliative care enjoyed greater patient satisfaction than members of the control group, and their symptoms were better managed.
Additionally, patients in the palliative care group reported better medical interactions after four months. In 2008, the Archives of Internal Medicine studied palliative care implementation as a method to reduce costs. Five thousand patients receiving palliative care were studied in comparison to twenty thousand patients who did not receive palliative care. Of those who survived their illness, palliative care saved $1,696 per admission and $279 per day. Of patients who succumbed, palliative care reduced costs by $4,908 per admission and by $374 each day. These cost reductions were evident in pharmacy costs, laboratory fees and patient time in the ICU.
Failures in the System of Care
Of the corrections suggested by the report issued by the Institute of Medicine, payment services is high on the list of issues that can severely hinder access to quality palliative care. The report strongly recommends a reorientation of incentives to promote the use of social services, coordinated care and end of life planning. Currently, the payment system focuses on acute care treatment. Secondly, there is a serious lack of skilled providers dedicated to palliative care. This specialist area is very small, despite growth in the industry. Training dedicated to end of life care is of critical importance to expand access to this field of medical providers. In November of 2013, Becker’s Hospital Review published a report stating that palliative care in larger hospitals had expanded from 20% in 2000 to 70% in 2013.
However, numbers of trained palliative care providers are still low, due largely to the spending cap on Medicare funding to educate experts in palliative care. The IMO report recommends that palliative be accessible and integrated at end of life. Communication is key in this situation, and connections between patient, family, community and caregivers must be established early and kept strong.
Increasing Palliative Care Nationwide
Increasing access to palliative care need not only be the responsibility of hospitals. Palliative care training should give providers information on available resources and how to guide patients to those resources. The entire healthcare system needs to work to create new resources and develop and expand existing ones to improve access to palliative care. Access to dedicated specialists in palliative care can greatly improve quality of life, ease end of life for patients and their families, and reduce costs.
Harbor Light Hospice provides palliative care to patients afflicted with a chronic or life-limiting illness. To learn more about how our palliative care services can help you, call us or send us a message online today. We are able to provide compassionate care to you or your loved one during difficult times.
