Integrating palliative consultations into care management for heart failure patients improves utilization and fosters greater understanding among referring clinicians, research from the Veteran Affairs (VA) Connecticut Healthcare System has found.
VA Connecticut Healthcare System researchers recently rolled out the educational study to determine whether consultative services would boost palliative care referrals for hospital-based heart failure patients after seeing a decline in admissions.
Palliative care was utilized by 6.5% of roughly 100 heart failure patients admitted to the West Haven, Connecticut-based VA hospital between October 2019 and September 2020, according to the study’s findings, recently published in the BMJ Supportive & Palliative Care journal.
After piloting a clinician education model dubbed the Plan-Do-Study-Act (PDSA) cycle, palliative care referrals increased to 28% of 109 patients, the research found.
“Point-of-care education was an effective tool to teach medical teams about the benefits of palliative care,” researchers indicated in the study. “Inpatient teams more consistently and independently considered palliative care for patients with heart failure, representing a cultural shift.”
The health system operates the West Haven VA Medical Center, a hospital that provides hospice, palliative, primary care and specialty health services such as mental health, cancer treatments and physical and rehabilitative therapy, among others. It also operates nine clinics in eastern Connecticut.
Interdisciplinary palliative care teams at the VA hospital received point-of-care training on how to broach these conversations with patients, resulting in an “upward shift” in utilization, researchers indicated.
The initial goal of the PDSA educational pilot was to increase palliative care referral volumes by 20%, but the model surpassed that by nearly 10%.
The VA hospital also saw palliative lengths of stay extend through the PDSA initiative. The mean length of stay for newly admitted palliative care patients was eight-and-a-half days.
Seniors represented the bulk of the new palliative care referrals. The average age of heart failure patients admitted to palliative services was roughly 81 years old, the research found.
The study’s results could have wider implications around quality of care for serious and terminally ill patients, according to the VA researchers.
“This quality improvement model may serve as a paradigm to improve the care of heart failure patients,” they stated.
