Advanced Heart Care at Home
2018 • Penn Medicine Center for Health Care Innovation
Problem + opportunity
Heart failure (HF) is a chronic, progressive condition affecting millions of people. It is the leading cause of death for both men and women. At the end of life, HF patients are often in and out of the hospital. Home palliative care has been shown to reduce these hospital admissions, reduce overall mortality, and give patients more quality days at home.
Despite these important benefits, few heart failure patients at Penn received palliative home care. Those who did go on palliative care received services for an average of 5 days, which is too short to fully experience the benefits. An interdisciplinary team wanted to answer an obvious question: If home palliative does all these great things, why aren’t our patients benefiting from it?
Action
Identifying barriers
Early on, interviewed and observed key stakeholders. We learned that physicians had misconceptions about palliative care, viewing it as “death care.” Cardiologists were unsure of when to socialize the idea of home palliative care with patients, and often started the conversation too late. Traditional home palliative care was not equipped to meet the needs of HF patients. Specifically, HF patients require careful weight monitoring and management of fluid overload.
Patient identification
With the help of Penn’s data science team, we developed an algorithm to identify HF patients who were appropriate for home palliative care.
Specialized home care
We brought aspects of hospital care into the home. Importantly, we made it possible for patients to receive IV diuretics at home, thereby preventing hospital admissions and keeping patients comfortable at home.
Process re-design
Despite these efforts, cardiologists remained reluctant to discuss palliative care with their patients. In order to address this, I led the development of a new referral process. A palliative care liaison began consulting appropriate patients in the hospital, effectively taking the conversation off the cardiologist’s hands. The liaison then supported the referral process for amenable patients. This proactive, opt-out approach increased enrollment 15x, helping us to grow the service.
Impact
AHCAH is an established service. What began as an exploratory project is now a standard service within Penn Home Palliative Care.
Patients spent more quality days at home. AHCAH patients spent 38 days on palliative care on average, compared to 5 days at baseline.
More patients benefited from specialized home care. The monthly census of HF patients on home palliative care grew from 7 at baseline to over 60.
Home diuretics kept patients out of the hospital. 91 patients in FY 2017 received home IV diuretics instead of going to the hospital.
Patients love AHCAH. 86% of AHCAH patients said they would recommend the service to a friend or family member.
Articles
Pitch Day 2018. Presentation begins at 2:36.
