Abstract

Objectives: Implementation in the U.S. of the Affordable Care Act and its penalties for hospital readmissions may be resulting in increased focus on palliative care and hospice in the hospital setting, especially with regard to those patients with a history of readmission. We examined how hospitals have used hospice and palliative care to help reduce readmissions and whether these efforts include partnering with post-acute care providers, such as nursing facilities and home health care agencies. It is thought that the coordinated efforts between hospitals and post-acute care providers may improve patient experiences and reduce readmissions.

Methods: We conducted interviews with 138 staff members in 16 hospitals and 25 nursing facilities in eight health care markets in the U.S. These interviews focused, in part, on efforts to reduce hospital readmissions.

Results: Findings show that hospitals have been improving pathways to palliative care and hospice services as one way of reducing readmissions. For example, one hospital began a program to provide palliative care consults in the emergency department with an eye toward diverting admissions or readmissions. Another had trained all of their advance practice nurses in palliative care and required these nurses to have advance care planning conversations with all patients. Some nursing facilities had also sought to reduce their readmissions through increased use of advance care planning and palliative care. However, in only two markets were hospitals partnering with post-acute care providers in their efforts. In one case, the hospital provided education to the nursing facilities in the market around advance care planning and the need to have these types of conversations with residents. In another city, the hospital system had embedded hospice physicians within their home health care interdisciplinary team to ensure that appropriate patients received in-home palliative care consults. However, only patients in the system-owned home health care service were included, which meant that other patients who could have benefitted from the consults did not receive them.

Conclusions: Our findings suggest ways that hospitals and post-acute care providers could be partnering to better provide palliative care and hospice services to patients. Increased use of such partnerships may have the added benefit of reducing readmissions.