March 2018

HIT Happenings: Tools for Tough Decisions: Analytics in Palliative Care
By LeAnne Hester
For The Record
Vol. 30 No. 3 P. 30

Palliative medicine may be one of today's most misunderstood disciplines, both by patients and family members. Palliative medicine aims to improve the quality of life and provide comfort to patients living with chronic or terminal illness—at any stage of the illness, not just at the end of life.

Hospice care is a subcategory of palliative care and focuses primarily on terminal illness and end of life. Approximately 90 million people in the United States are living with a serious illness, and almost 90% of hospitals (consisting of at least 300 beds) feature a palliative care program.

Despite the prevalence of palliative care teams in hospitals, there are a number of challenges that hinder access, including poor hospital culture and awareness, a lack of education about the range of palliative care services, and an inability to identify patients who need care. Addressing these concerns greatly reduces suffering in the most effective manner.

Toward that goal, some organizations have turned to analytics-enabled technology, which offers opportunities to improve palliative care delivery in several ways.

Identify Patients Requiring Care
Technology can help better identify the right candidate for palliative care. Traditional screening tools for identifying patients with palliative needs are often manual and cumbersome, making it hard to paint an accurate picture of the patient's health. Because traditional screening tools and triggers make it difficult to identify palliative care patients, clinicians often provide palliative care consults too late in the process to provide benefit.

Clinical monitoring tools that use real-time predictive analytics offer great insights into a patient's current health. Clinicians can better identify those in need of palliative care when they have a clear picture of a patient's current and projected state of health. Moreover, clinical tools and analytics give care teams, patients, and their families objective data to help them make appropriate decisions regarding their palliative care treatment.

Optimize Quality of Life
Not all patients facing chronic or terminal illnesses will necessarily benefit from treatment. For example, end-of-life care can be aggressive and costly for patients with advanced cancer. Reducing interventions in the last months of life for oncology patients may or may not offer them improved comfort and quality of life.

Life expectancy estimations for oncology patients have historically been inconsistent and don't always provide clinicians a complete picture from which to best address patients' care goals. However, using analytics within a palliative care program not only paints a more holistic picture of the patient's health, but also provides prognostic tools and predictive models that help clinicians, patients, and their families decide on a realistic care plan.

A recent study from Yale Cancer Center/Smilow Cancer Hospital resulted in the creation of the Imminent Mortality Predictor in Advanced Cancer (IMPAC), a predictive model that uses objective data from EHRs to generate life expectancy probabilities in real time. IMPAC leverages clinical surveillance technology to measure hospitalized oncology patients' likelihood of death within 90 days to help determine what further aggressive treatments may or may not be warranted.

In this type of predictive model, clinicians and patients can better determine when a patient's quality of life would benefit from choosing not to seek treatment as part of his or her palliative care.

Minimize Patient Length of Stay
Not only does clinical technology help identify the right patients for palliative treatment but it also enables those patients to receive more effective care. In turn, patients can be discharged sooner, thus reducing their lengths of stay.

Yale New Haven Hospital recently conducted a pilot study that incorporated clinical surveillance tools into a trigger for palliative care. The study found the mean length of stay for patients receiving palliative intervention decreased from 26.3 days for all other groups to 13.9 days. Furthermore, the 30-day readmission rate was reduced from 25% in the nonpalliative care group to 4% in the intervention group.

By improving the prevention of 30-day readmissions and reducing length of stay for Yale New Haven Hospital's palliative care patients, the results of this study demonstrate the benefits of clinical surveillance tools and triggers in palliative care.

Provide Cost Savings
The cost of care strains the health care system as well as patients and their families. There is a particular need to improve quality of care and help reduce costs as the baby boomer generation ages and the elderly population increases. Today, approximately 68% of Medicare costs are tied to patients with at least four chronic conditions—a typical palliative care patient, according to the Center to Advance Palliative Care, which estimates US hospitals could realize up to $6 billion in annual savings if palliative care were fully utilized.

In fact, the Yale New Haven Hospital study on length of stay found that costs were lowered by 54% for patients receiving palliative intervention. Additionally, a widely cited study on cost savings associated with US hospital palliative care found an average 400-bed hospital with palliative care consultation could realize net savings of $1.3 million per year.

The findings of both studies illustrate how clinical technology and analytics in palliative care can help bend the cost curve.

Analytics can also help reduce costs for patients not undergoing treatment. Because end-of-life care can be expensive, using clinical tools and predictive models to best determine whether treatment is appropriate can reduce costs for patients whose quality of life would not improve with treatment. In fact, Yale Cancer Center's IMPAC study estimated a potential cost savings of $15,413 per patient—the potential avoidable cost of $17,861 minus the cost of hospice ($2,448).

Choosing not to seek treatment can be a difficult decision for patients and families. However, an informed decision can help improve the patient's quality of life and realize significant potentially avoidable costs.

Spreading the Word
There is a general lack of understanding around palliative intervention and end-of-care options for patients and their families. As such, the health care industry must aim to raise awareness and improve access to expert palliative care teams in hospitals.

Clinical technology and analytics have tremendous potential to overcome the obstacles to effective end-of-life care. Not only do these tools help doctors and patients determine whether treatment is the best course of action but they also help to better identify appropriate patients for palliative intervention as part of their end-of-life care. Moreover, clinical tools and analytics can help to reduce the length of stay for palliative care patients and decrease costs whether or not treatment is sought.

In the end, the benefits of analytics technology and clinical surveillance tools amount to improved care and comfort for patients and their families, as well as better clinical outcomes and more efficient use of resources for hospitals and the health care industry at large.

— LeAnne Hester is chief commercial officer at PeraHealth.