Abstract: FR-PO964
Optimizing Palliative Care Referrals for Veterans with Kidney Disease in the Iowa City VA Health Care System
Session Information
- CKD Interventions: Trials and Quality Improvement
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Swee, Melissa L., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Shi, Qianyi, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Sarrazin, Mary Vaughan, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Griffin, Benjamin R., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Yamada, Masaaki, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Sambharia, Meenakshi, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Jalal, Diana I., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
Background
The kidney clinic at Iowa City VA (ICVA) sees 20-40 patients weekly, with an estimated 5-15% benefiting from palliative care referrals. Hospice aims to enhance end-of-life quality and enable death at home. However, the lack of quality metrics in the industry hinders care assessment. National median length of stay (LOS) in hospice was 18 days in 2018. In ICVA, only 1.8% of palliative care referrals were for kidney disease patients, with a median LOS of 14 days, highlighting the need for improvement.
Methods
We aimed to evaluate delays in kidney disease referrals to palliative care and enhance appropriate referral percentage. Mixed methods were used, reviewing referral data and examining qualitative barriers. Three iterative Plan-Do-Study-Act (PDSA) cycles were implemented. The first focused on educating the kidney team to consider the patient holistically. The question, "Would death within six months not be unexpected?" was introduced. The second involved a multidisciplinary conference, broadening education. The third proactively reviewed charts of returning patients to identify referral candidates.
Results
Analysis using a Statistical Process Control (SPC) p-chart showed consistent low referrals (<10% of eligible Veterans), indicating the need for improvement. Barriers identified included concerns about time required for discussions and referrals.
Conclusion
Our project has not entered the sustainability phase, as there has been no significant improvement in referrals for eligible patients. Further iterative PDSA cycles are necessary to integrate palliative care effectively. Future efforts will focus on reducing rural disparities in accessing palliative care through virtual visits. We aim to align resources in the kidney clinic, increase efficiency, and consider implementing an opt-out process for Veterans on dialysis or with significant kidney disease. By addressing these challenges, we aim to improve appropriate palliative care referrals, enhance end-of-life care for kidney disease patients at ICVA, and provide early access to specialized person-centered care, ultimately improving their quality of life.
Funding
- Private Foundation Support