Community-Based Palliative Care Certification Reduces Readmissions | Joint Commission
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Community-Based Palliative Care Certification Reduces Readmissions

Oct 30, 2017 | 994 Views

Mitzner,_Irian_fsBy Irina Mitzner, RN
Vice President of Clinical Operations and Nurse Executive, Northwell Health

Today’s palliative care is more individualized and goal-oriented than ever before, but there is still often a gap when it comes to receiving care outside hospital settings. All too often, palliative care is seamless in the in-patient setting but becomes disjointed when the patient moves home.

As part of the largest hospital system in the state of New York, we at Northwell have had an extremely robust hospice and palliative care program that has incorporated home care for many years. Our pride points included:

  • identifying a patient’s possible palliative needs at discharge

  • doing consults in the hospital

  • discharging qualified patients directly to hospice

  • addressing palliative needs in home care

Beyond Comfort Care

By most measures, Northwell Health was really ahead of the curve. However, I’d been keeping tabs on industry trends and knew that the paradigm had shifted in the last few years. 

The most advanced palliative care providers were looking beyond the comfort measures of the past. While it’s still extremely important to manage symptoms, I knew that the industry leaders were moving beyond that to:

  • address patient goals

  • coordinate the interdisciplinary care team

  • concentrate on spiritual and psycho-social needs

What I didn’t know was how to get Northwell to that next level. At Home Care 100 Leadership Conference, I heard the buzz about The Joint Commission’s Community Based Palliative Care Certification and was attracted to the idea that its central themes were:

  • access to information

  • patient choice

What Gets Measured, Gets Noticed

Another appealing concept was that The Joint Commission established processes to support coordination of care, which is exactly what we needed.

Another goal was to fine-tune our performance measure reporting. As The Joint Commission required data for five performance measures over a four-month period, I knew that was the right amount of time to refine our performance measure metrics.

Now that our certification journey is complete and we’ve achieve Joint Commission Palliative Care Certification, I am amazed by how much the program’s framework helped us clarify our goals. I can’t think of a better example to illustrate this than in our measurement of pain management. 

Because of what we learned during certification, we’ve changed our methodology for capturing success with pain management, as well as shortness of breath and preparing patients for discharge. In short, we’ve factored patient expectation into the pain management equation. Our goal is to further engage the patient in his own pain management and measure how well we meet the patient’s expectation. Say, for instance, the patient reports a pain level of 5. Instead of arbitrarily focusing on lowering the pain score, we now work hard to maintain the patient’s comfort as a 5 on the scale. The Joint Commission taught us that we don’t have to focus entirely on the 1-10 pain score—the patient’s comfort level is what really counts, not the number.

Our readmission data also has improved considerably post-certification. Northwell’s home care readmissions had hovered at 16.5% for some time. After certification, they quickly dropped to 15%. This is below our overall readmission average (15.7%), as well as the national average (16.7%) and the state average (17.4%).

The certification has also given us the impetus to implement some new ideas, such as in-home consultations. We’re working with The Joint Commission to explore logistics behind establishing an ongoing consulting program after discharge from home care. We’re finally on the road to linking patients and physicians with the resources that will keep patients in the community longer.

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