Advancing the Science

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February 19, 2019

It takes a village

By Elizabeth Zimmermann

Home-based palliative care may not be a simple doctor-patient relationship, but the value it adds is simple to understand

It takes a village to raise a child. The inputs and interactions with many adults across their community serve to usher children through the ups and downs of life into adulthood and aid them to live well, and become a productive member of society.

This same analogy is used by Christina Y. Chen, M.D., a community medicine physician at Mayo Clinic in Rochester, Minn., when describing home-based palliative care.

“It takes a village – a community of caregivers,” she says, “to provide high quality, patient-centered care for people in our aging population, to help them live well throughout their lives.”

She is part of an interdisciplinary team that has been researching and developing home-based care programs designed to meet people where they are, especially older members of the community. An extension of Mayo Clinic’s Care Transitions Program, home-based palliative care, which Mayo Clinic began in 2011, has always been cutting edge, she says.

“From the beginning, patients who were in this program experienced fewer hospitalizations and fewer days spent in the hospital. Plus, almost 100 percent of patients took advantage of advance care planning,” says Dr. Chen. These outcomes are described in an earlier study.

World Health Organization

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

In their most recent study, the team describes the financial success of the program.

Published in the Journal of Pain and Symptom Management, the report shows annual Medicare expenditures were reduced by $18,251 per program participant compared with matched control patients.

“This supports the role of home-based palliative medicine in delivering high-value care to high-risk older adults,” says Dr. Chen.

“It’s not just about the financial sustainability of this program itself – although the numbers speak for themselves,” she continues. “The beauty of this program is that it carries substantial value across the continuum of health care. It addresses patient needs, improves quality of life for patients and caregivers, reduces hospital stays and clarifies the patients’ wishes in the context of health decline, all while reducing costs.”

Understanding care needs in the community

Gregory Hanson, M.D., another community medicine physician at Mayo Clinic, is the lead champion for the home-based palliative care program and other related ones that are being developed and tested.

“In 2011, approximately 2 million people in the U.S. were over the age of 65 and homebound,” says Dr. Hanson. “Current estimates indicate there could easily be twice that many homebound elders by 2035.”

“One of our main goals for our practice is to find the best person-centered ways to care for elders in our community,” he says. “This is about engaging the whole team, meeting the patients where they are, and finding the best ways to improve quality of life and the value of health care.”

“In addition to palliative care, we offer hospital at home, primary care at home and a care transitions program designed to enable patients to recover at home after hospitalization, improving their overall wellbeing in the process,” says Dr. Hanson.

“We continue to study the needs in our community in a holistic manner, looking at physical, emotional and spiritual needs,” he says. “We are committed to finding the best ways to address those needs.”

It takes a village … or a team

“This vision and these programs didn’t just develop overnight,” says Dr. Hanson. “We have team members from across health care – care coordinators, nurses, physicians, nurse practitioners, social workers and pharmacists – coming together to build and deliver these new care models.”

“While we developed these for our patients, we also hope that our research findings will spark practice changing strategies across the nation,” he says.

“The research team provides a critical component to our ability to meet the needs of patients here and afar,” echoes Dr. Chen. “We’ve partnered with Mayo’s Center for the Science of Health Care Delivery all along. They have mentored us in our research and program development, and without their skills in data extrapolation and analysis, as well as expertise in defining the research questions, we wouldn’t be able to share the successes we have thus far.”

“It takes a village to do research, and it takes a village to take care of one patient,” she says. “It’s all in the spirit of advancing practice, education and research, so that we may all continue to do better as providers and as people.”

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The authors of the current study include two physician alumnae of the Kern Health Care Delivery Scholars mentored training program within the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, as well as other center experts. The center is an innovative driver of change for Mayo Clinic, and transforming the experience of health care for all patients. To grow the ranks of experts in this field, the center also trains researchers and providers to solve the complexities of the health care system from within.

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Tags: care transitions, Center for the Science of Health Care Delivery, Christina Y. Chen, collaboration, Findings, Gregory Hanson, Kern Health Care Delivery Scholars, News, palliative care, population health, quality of life

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