1. Jennifer Ritzau, MD Director of Palliative Care June 10, 2016
Palliative Care Adding Value in Health Care CTC-RI Breakfast of Champions
Jennifer Ritzau, MD
Director of Palliative Care
June 10, 2016

2. What is palliative care?
Medical care especially designed for people living with a serious, life-threatening illness
Not limited to “comfort only”
Not limited to terminally ill patients
Not a euphemism for hospice care
Work with the existing health care team to provide an extra layer of support to patient and family

3. The Serious Illness Continuum

4. What do we do? Symptom management Goals for care discussions
Advance Directives
Delivering serious news
Addressing emotional and spiritual needs
Assist with prognostication
Assisting with transitions in care

5. We have excellent quality data on our side
Improved quality of life
Improved patient and team satisfaction
Diminished caregiver distress
Improve symptom burden
Increase in advance care planning
Improvement in survival
Irwin et al Chron Respir Dis 2012; 10(1) 35-47
Glare P JNCCN 2013:11 (supp 1):s3-9
Casarett et al J AM Ger Soc 2008:56 (4)
Elsayem et al J Clin Oncol 2004;22 (10)
Higginson et al J Pain Symptom Manage 2003; 25(2)
Ringdal et al Pain Symptom Manage 2002; 24 (1) 53-63
Temel et al N Engl J Med Dec 2;363(23):2263

6. Cost / Quality Care Gap Care Gap Tier 3A 5 % Population 50% Cost
Stage 1
Stage 2
Stage 3
Care Gap
Terminal
Mourning
Stage 4
CHRONIC DISEASE
220 Years
SERIOUSLY ILL
1824 Months
HOSPICE
6 Mos or Less
GRIEF SUPPORT— MAYBE
Tier 3A
5 % Population
50% Cost 6

7. To be of Value in health care today

8. Barriers Abound…
Health Care System
Patients
Families
Providers

9. Primary Palliative Care
Patients would rather YOU be the “someone who can”
Bring value to the patient encounter
What is important
What will this next test/admission accomplish
Overwhelming evidence that better communication skills combats physicians burnout, reduces angry patients, litigation

10. Primary Palliative Care
Elicit what is most important to you patient
Be Honest “I am worried about how sick you are”
Advance care planning
Basic symptom management for seriously ill patients ( pain, dyspnea, nausea, anxiety)

11. Suboptimal communication creates a vicious spiral that makes us feel more like hamsters on a wheel than healers… Anthony Back et.al

12. Patient’s Preference
Elders asked to rank living longer, good pain and symptom control or maintaining independence…

13. Survey says…
76% Maintain Independence
Good pain and symptom management
Living longer
This is NOT withholding or rationing care- this is aligning care with preferences…added value

14. As a result of a failure to prognosticate,
let alone prognosticate accurately,
patients may die deaths they deplore
in locations they despise
Nicholas Christakis (Emergency Physician Feb 2014, p24-25)

15. What Would You Want? To take a last vacation?
Spend time with your kids?
Get your affairs in order?
Go back to your NH where everyone knows you?
Something different than what out patients are going through?
When we wait until the last minute, we rob our patients of this time and irreplaceable memories.

16. Support
Dignity
Privacy
Help for your family
Best symptom control possible

17. Do our patients and families deserve anything less?

18. Call if We Can Help! Hope Hospice and Palliative Care 782-0725
Inpatient consults at RIH, TMH, Newport and SCH
Consult service some LTC Facilities
Skilled Home Care – Visiting Nurse Hope Health
Hope Palliative Care Center (clinic)