Clinicians often lack exposure to palliative care during their medical training – an issue blocking growth of this workforce during a time of rising demand.
One key to growing the supply of palliative care clinicians hinges on data that demonstrates how these services improve patient outcomes.
Quality data can help health care leaders across the continuum visualize the return on investment of growing palliative care training initiatives/partnerships, according to Brynn Bowman, CEO of the Center to Advance Palliative Care (CAPC).
This kind of information can provide a blueprint for how clinical education can be more oriented around patient needs, as well as around pain and symptom management, Bowman said at a recent conference held in collaboration with the Coalition to Transform Advanced Care (C-TAC).
“The ideas underpinning all of this is that when patients’ needs are really complex, everyone should have access to a specialty team of palliative care specialists in whatever setting they’re receiving care,” Bowman said at the C-TAC-CAPC Leadership Summit in Washington D.C. “We can make the best case for investment in primary palliative care education when you have patient-reported outcomes [and] deep dives on what’s happening in patient care.”
Strategic palliative education initiatives built on quality outcomes
Seriously ill patients nationwide urgently need palliative support, according to Yusimi Sobrino-Bonilla, palliative care clinical supervisor and nurse at New Jersey-based Valley Health System. But many of them go without due to a lack of trained clinicians.
The Valley Health System has taken steps toward improving its palliative care delivery model across the care continuum. The health system convened a committee to assess unmet needs among its seriously ill patients and families. Members included clinical leaders, executives, marketing and outreach teams, volunteers, referral sources and input from patient advocates and family members.
Insights from patients, their family members and caregivers were a crucial part of gaining a bigger picture around what quality serious illness care can look like, Sobrino-Bonilla said.
Data on quality outcomes has become a part of that picture – one that comes with developing pathways to palliative training through partnerships between hospital and health systems as well as hospices and home health, she stated.
“We have realized that we’re going to need partnerships and worked with our home care and hospice agencies to identify the additional resources needed to grow our interdisciplinary team,” Sobrino-Bonilla said at the C-TAC-CAPC conference. “Our committee helped us realize that patient insights were what really made a difference … We’ve noticed an institutional change [and] palliative care has become an integral part of the care team. It’s been a game changer for us in terms of being able to provide this continuum of care.”
Electronic medical record data can help providers identify training gaps among their clinicians, particularly when it comes to advance care planning and palliative consultations, according to Lisa Simmons-Fields, director of system population health and care management at Trinity Health System. She is also president-elect of the Case Management Society of America in Detroit, Michigan.
Trinity Health in 2022 convened a panel of palliative care experts that included pharmacists, social workers, and providers in home health, hospice and primary care, among others.
Involving interdisciplinary team members has helped the organization gain insight around different touch points along a patient’s health care experiences and their impact on outcomes, Simmons-Fields said. Additionally, scouring EMRs can help clinical teams identify unmet needs, she stated.
“We integrated insight from conversations about the expectations of what we could deliver and what these palliative services meant to providers, as well as an assessment of community-based palliative care delivery,” Simmons-Fields said. “What we saw was that we truly weren’t meeting the needs and felt we needed our arms around having this care earlier. We needed to normalize these conversations and create communication skills pathways as a good way to help us be able to help people feel comfortable in that. We wanted it to not only structure the work, but also structure us in our educational processes across the continuum.”
EMR data can guide improvements in palliative quality and education, Simmons-Fields added.
In addition, metrics around advance care planning conversations can help providers understand when and where these are happening across different health settings, which can indicate wholes of where they aren’t as well, she explained.
“Having data on patients’ personal experiences in these ACP discussions is important,” Simmons-Fields said at the conference. “It can be a practical guide for teams when people are diagnosed and overwhelmed to make it a better journey for them. It changed that education piece as we started to see what we could do to change and really start communicating with one another across the care continuum. It’s moving this team of professionals upstream.”