Standardized criteria for initiating palliative care consultations can substantially improve the care of patients with advanced solid tumors, according to research from Mount Sinai School of Medicine, New York, led by Kerin Adelson, MD, Coordinator for Ambulatory Oncology Quality for the Tisch Cancer Institute.1
At a press briefing in advance of the 2013 ASCO Quality Care Symposium, Dr. Adelson described the 3-month pilot program, which evaluated whether the use of standardized criteria could improve palliative care services and outcomes. Prior to the study, no guidelines were available for identifying which patients with advanced solid tumors most warranted palliative care consultation, she said.
“Despite a top-rated palliative care division at Mount Sinai, our solid tumor division utilized palliative care and hospice less than other medical centers. We hypothesized that implementing standardized criteria for palliative care consultation would improve these metrics,” she said.
Criteria Developed From Literature and Guidelines
Dr. Adelson and her team developed criteria based on extensive literature review and discussions with oncologists and palliative care specialists. The criteria stipulate that palliative care consultation is warranted for patients with any of the following: stage IV solid tumor, stage III pancreatic or lung cancer, hospitalization within the prior 30 days, prolonged hospitalization (> 7 days), and uncontrolled symptoms, including pain, nausea, shortness of breath, delirium, and psychological distress.
Standardization Leads to Multiple Improvements
Over 3 months, 68 patients met the criteria for consultation, and their outcomes were compared to 51 similar patients seen in the 6 weeks prior to intervention (preintervention group). Palliative care consultations increased from 41% to 82%, 30-day readmission rates dropped from 36% to 17%, and use of hospice services rose 14% to 25%, Dr. Adelson reported.
Comparing the pilot group’s outcomes to the aggregate University Health System Consortium data from the previous year, the researchers showed that standardization reduced 30-day readmission rates from 21.7% to 13.5%, and improved the mortality index from 1.35 to 0.59.
“Formalizing criteria for a palliative care consult was easy to implement, highly effective, and led to improvements in multiple quality measures,” Dr. Adelson said. ■
1. Adelson K, et al: Standardized criteria for required palliative care consultation on the solid tumor oncology service. 2013 Quality Care Symposium. Abstract 37. Presented November 1, 2013.