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Palliative Care Quality Network
November 8-9, 2012
Steven Pantilat, MDDirector, Palliative Care Quality Network
Characteristics
Number of patients 136
Symptom Assessments Mean= 2.1, median=1.0, range= 0 – 13
Age (Years) Mean=74, Median=78, Range: 23 – 99
Gender (Female) 54.1% (73/135)
LOS pre referral (Days) Mean= 4.6, Median= 2.0, Range: 0 – 47
Patient characteristics
0 10 20 30 40 50
Med Surg.
Critical care
Telemetry Step/down
Emergency Dpt
SNF
Acute rehab
Other
Frequency (%)
Refe
rral
Lo
cati
on
Location at time of the referral
Critical care referrals by hospital
1820
45
50
5
28
0
10
20
30
40
50
60
1 2 3 4 5 Mean
Fre
qu
en
cy (
%)
Hospital
0 10 20 30 40 50
Hospice referral
Goals of care
Advance care plan.
Pain manage.
Symptom manage.
Withdraw life prolong. Intervent.
Transfer to CCS
Comfort care
Other
Frequency (%)
Reaso
n f
or
refe
rral
Reasons for referral
Referred for pain management by
hospital
15
28
0
21
27
17
0
10
20
30
40
50
1 2 3 4 5 Mean
Fre
qu
en
cy (
%)
Hospitals
p=0.03
0 10 20 30 40 50
Cancer
Infectious
Cardiac
Neurologic
Dementia
Complex Cond.
Renal
Pulmonary
Hepatic
Vascular
Gastro
Other
Frequency (%)
Pri
mary
Dia
gn
osis
Primary diagnosis
Proportion of patients diagnosed with
cancer
3840
7
46 46
35
0
10
20
30
40
50
1 2 3 4 5 Mean
Fre
qu
en
cy (
%)
Hospital
p= 0.007
Documentation of desired care
45
5
50
0
10
20
30
40
50
60
Full Partial DNR/DNI
Fre
qu
en
cy (
%)
Code Status (n=130)
1510
0
10
20
30
40
50
60
Adv. direct. POLST
N= 136
0 10 20 30 40 50 60 70 80 90 100
MD
SW
RN
Chaplain
NP
CNS
Other
Frequency (%)
Dis
cip
lin
es
Disciplines involved in consultation
Number of disciplines per consultations
2
41
18
14
18
7
0
10
20
30
40
50
0 1 2 3 4 5
Fre
qu
en
cy (
%)
Number of disciplines involved in consultation
Disciplines per consultation for each
hospital
2
3
1
2
3
2
0
1
2
3
4
5
1 2 3 4 5 Mean
Dis
cip
lin
es
pe
r c
on
su
lta
tio
n
Hospital
p= 0.005
Family meetings per hospital
3
2
1
2
1
2
0
1
2
3
4
5
1 2 3 4 5 Mean
Nu
mb
er
of
fam
ily m
ee
tin
gs
Hospital
p= 0.001
Mean palliative performance scale
3538 39
32
53
39
0
20
40
60
80
100
1 2 3 4 5 Mean
Fre
qu
en
cy (
%)
Hospital
p= 0.002
0 10 20 30 40 50
Home
ECF
Died
Inpatient
LTAC
Died before consultation
Other
Frequency (%)
Dis
po
sit
ion
Discharge disposition (N= 117)
Proportion of patients that died per
hospital
7
16 17
46
6
19
0
10
20
30
40
50
1 2 3 4 5 Mean
Fre
qu
en
cy (
%)
Hospital
p= 0.003
Assessment of symptoms (n= 136)
Symptom Assessed
(n)
Addressed
(n)
%
Pain 98 57 58
Non-Pain symptom 102 62 61
Psychosocial 105 69 66
Spiritual 84 53 63
Desired care clarified or completed
53
3
13
0
10
20
30
40
50
60
Code status Adv. Direct. POLST
Fre
qu
en
cy (
%)
Documentation
0
20
40
60
80
100
Pain Anxiety Nausea Dyspnea
Fre
qu
en
cy (
%)
Symptom
None Mild Moderate Severe Unable to report
n= 119 n= 119
Initial Symptom Assessment
} } } }
43 25 12 21
n= 118 n= 117
15
39
5660
23
44
20
57
23 20
43
0
20
40
60
80
100
Pain Anxiety Nausea Dyspnea
Fre
qu
en
cy (
%)
Symptom
Worse 1-point No Change Improved 1-point Improved 2-points
n= 9n= 26 n= 5 n= 7
Improvement in symptom 24 hrs. after
initial assessment
Proportion of patients ‘unable to report
pain’ per hospital
21
4
0
33
27
16
0
10
20
30
40
50
1 2 3 4 5 Mean
Fre
qu
en
cy (
%)
Hospitals
p= 0.003
