Over half of the United States health care costs stem from those seriously ill and those with multiple chronic conditions. Conversely, these patients only constitute 10 percent of all patients in the nation. An approach to decrease costs associated with these expenditures and improve the quality of life and care for these patients was a priority in 2008. The National Priorities Partnership (NPP) reported in the National Priorities and Goals-Aligning Our Efforts to Transform America’s Helathcare, that one of the six main priority areas that would significantly improve the quality of health care delivered to Americans, if addressed, was palliative care (Meier D. E. (2011). This was identified as a priority, despite costs, due to the evidence that these patients receive inadequate quality of care, which is often times overused, fragmented, prone to medical errors, and produce poor quality of life.
Seriously ill patients and those with multiple chronic conditions have two options for preserving and enhancing their quality of life; hospice services or palliative care. Although hospice and palliative care are both end of life options, they differ in their approach. Hospice differs from palliative care by the prognosis of living less than six months, whereas palliative care eligibility has no prognosis restriction. Palliative care develops on the needs of the patient. For hospice patients, they often forgo curative treatment and therapies since this would not hinder the disease following its natural course. Forgoing these curative services and therapies allows the patient and family to focus on maximizing comfort and quality of life. The prognosis distinction was an important determining factor for establishing and integrating palliative care that recently led to its rapid growth in the United States.
In order to improve the value, quality, and cost of the services provide to those with serious illness, essential structural elements such as an interdisciplinary clinical team, 24/7 access and responsiveness from the care team, appropriate staffing ratios, and sufficiently trained staff credentialed and/or certified in palliative care are necessary. So how exactly does hospice and palliative care improve quality of care? Both approaches have demonstrated the ability to improve “physical and psychosocial symptoms, family caregiver well-being, bereavement outcomes, and patient, family, and physician satisfaction” (Meier D. E. (2011). An interdisciplinary team is swift to address distressing symptoms, circumventing potential hospital admissions and complications. Communication and setting appropriate goals with the patient and family leads to informed decision-making, resulting in clarity of the care plan, and consistency. The delivery of care through hospice programs and palliative care promotes coordinated, patient-centered, and communicated care, which reduces the costly drivers of increased hospital, specialists, and procedural utilization. To help successfully achieve this priority set by the National Priorities Partnership, it will take the efforts of both private and public sectors to sustain commitment to bring palliative care to those suffering with serious illness and chronic conditions.
Meier D. E. (2011). Increased access to palliative care and hospice services: opportunities to improve value in health care. The Milbank quarterly, 89(3), 343–380. doi:10.1111/j.1468-0009.2011.00632.x