Heart Failure-Related Palliative Care through Education and Standardized Referral
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Heart failure is a complex syndrome affecting over 5.7 million Americans. The annual cost of heart failure in the United States is $31 billion with much of that occurring toward the end of life. Providers struggle with predicting the trajectory of the condition, leaving many patients without resources to make informed decisions and an overall decrease in their quality of life. The purpose of the Standardized Palliative Care Referral for Heart Failure evidence-based quality improvement project was to determine if education and a standardized referral process would increase the number of heart failure related palliative care referrals at an ambulatory heart failure clinic. The project was quasi-experimental with a pretest, posttest assessment of heart failure related palliative care referrals along with provider and patient characteristics. There were 12 cardiology providers who participated in the project. Twelve participating cardiology providers were educated on the palliative care benefits and the supportive guidelines. An alert was built into the electronic medical record based on ICD-10 heart failure codes. The alert fired at the beginning of the encounter and provided patient triggers on when to consider palliative care, allowing the provider to place the palliative care order from the alert. Outcomes measured included palliative care referral rates pre and post intervention along with follow-up care (readmission, emergency room visits, office visits). Results from the pre and post intervention were the same, revealing that 4% of cardiology encounters with heart failure patients resulted in palliative care referrals. Based on these results, further intervention should focus on changing the alert timing from the beginning to the end of the encounter.
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