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1 National Palliative Care Registry TM Data Summary (non-pediatric Palliative Care Programs) Bed Sizes HOSPITAL METRICS Hospital Ownership Public (government: federal, state, county city) Not-for-profit For-profit Location Urban Suburban Rural Teaching Hospital Yes No Hospital Metrics Mean # of hospital admissions Mean average daily census Mean hospital deaths Mean # of discharges PALLIATIVE CARE PATIENT POPULATION Patient Population Adults Only Adults and Children Patient Age Distribution to to to to to or older Patient Gender Distribution Female Male Patient Ethnicity Distribution Black/African America non-hispanic White/Caucasian non-hispanic Asian non-hispanic American Indian/Alaska Native non-hispanic Hawaiian Native/Pacific Islander non-hispanic Hispanic / Latino PATIENT VISITS Initial Consults Mean # of initial consults Median # of initial consults Minimum Maximum Page 1 of 10

2 Penetration Mean Penetration Median Penetration Minimum Maximum Billable Follow-up Visits Mean # of billable follow up visits Median # of billable follow up visits Mean # of billable follow up visits per initial consult Median # of billable follow up visits per initial consult Palliative Care Team Role % Consult Only % Primary % Co-manage % Depends on Circumstances Observation Beds & Emergency Department Sees Patients in Observation Beds Mean # of Obs Patients Sees Patients in Emergency Department Mean # of ED Patients SCREENING AND REFERRALS Standardized Trigger Tool No standardized trigger tool Yes, has standardized trigger tool Referral Source Location Medical/Surgical Mean Percentage At least 25% of all referrals At least 50% of all referrals At least 75% of all referrals Intensive Care Unit (ICU) Mean Percentage At least 25% of all referrals At least 50% of all referrals Oncology Mean Percentage At least 25% of all referrals Emergency Department Mean Percentage Telemetry / Step-down Mean Percentage At least 25% of all referrals At least 50% of all referrals Gastroenterology/Hepatology Mean Percentage General Pediatrics Mean Percentage Geriatrics ACE Unit Page 2 of 10

3 Mean Percentage MD Office / Home (direct admit) Mean Percentage Hospice Mean Percentage Referring Specialist Hospitalist Mean Percentage At least 25% of all referrals At least 50% of all referrals At least 75% of all referrals Oncologist Mean Percentage At least 25% of all referrals Cardiologist Mean Percentage Nephrologist Mean Percentage Pulmonary/Critical Care Mean Percentage Surgery Mean Percentage Neurologist Mean Percentage Gastroenterologist/Hepatologist Mean Percentage Internal Medicine Mean Percentage Family Medicine Mean Percentage Other referring clinical specialist Mean Percentage TJC CERTIFICATION, SERVICES INTEGRATION Joint Commission Advanced Certification for Palliative Care Yes Yes, and have been re-certified Preparing to apply Not eligible Program does not have requirements Not Planning on applying Relationship: Hospice No relationship exists One administrative entity Administratively separate Contracts in place Informally collaborate Other Relationship: ICU Page 3 of 10

4 Rarely see ICU patients No formal coordination Work collaboratively to develop system ICU has plans for palliative care Relationship: Emergency Medicine Rarely see EM patients No formal coordination Work collaboratively to develop system EM has plans for PC care Electronic Health Record Hospital EHR Has a Hospital EHR Cerner Epic Meditech Palliative Care Program EHR Has a Palliative Care Program EHR Cerner Epic Meditech Custom Palliative Care Reports Yes, gets custom palliative care reports from EHR No DIAGNOSIS AND CODE STATUS Diagnosis Cancer Mean Percentage At least 25% of all referrals At least 50% of all referrals Cardiac Mean Percentage At least 25% of all referrals Pulmonary Mean Percentage At least 25% of all referrals Complex chronic/failure to thrive Mean Percentage At least 25% of all referrals Renal Mean Percentage Vascular Mean Percentage Congenital / Chromosomal Mean Percentage Infectious/Immunological Mean Percentage Gastrointestinal Page 4 of 10

5 Mean Percentage Hepatic Mean Percentage Hematology Mean Percentage Endocrine/Metabolic Mean Percentage In-utero complication / condition Mean Percentage Neurologic/stroke/neurodegenerative Mean Percentage Dementia Mean Percentage Trauma Mean Percentage Code Status (mean %) Full Code Limited Code DNR/DNI Unknown DISCHARGES Discharges Discharged Alive Died on Palliative Care Discharge - Place of Origin (mean %) Discharged to Same Place as Origin Discharged to Different than Origin Unknown Status Discharge Location (mean %) Home (including Home Hospice & Assisted Living) Skilled Nursing Facility (SNF) Inpatient or Residential Hospice Acute Inpatient Rehabilitation Facility Long-term Acute Care Hospital (LTAC) General Hospital Other LENGTH OF STAY Initial Consult Completed Within 1 Day of Referral Within 1 Day of Hospital Admission Not Able to be Seen Before Discharge Discharged Alive Admission to Consult: Mean Admission to Consult: Median Consult to Discharge: Mean Consult to Discharge: Median Overall: Mean Page 5 of 10

6 Overall: Median Died on Palliative Care Admission to Consult: Mean Admission to Consult: Median Consult to Discharge: Mean Consult to Discharge: Median Overall: Mean Overall: Median Readmission within 30 days Mean number of patients readmitted within 30 days Readmission Rate (# readmitted / # discharged alive) Mean Median STANDARDIZED PROCESSES Plans in Place Marketing Bereavement Education Quality Improvement Patient and Family Satisfaction Survey % of programs that measure patient/family satisfaction If yes, % of programs that use a standard instrument If yes, mean survey response rate Telemedicine Yes, Audio and Video No, audio only (phone only) No, neither Team Wellness Yes, program has policies promoting team wellness No team wellness policies PAIN AND DYSPNEA Pain Dyspnea Percent of patients screened for pain Mean percent If screened, percent that screened positive for pain Mean percent If positive, percent with clinical assessment in 24 hrs Mean percent If positive, percent with pain improvement in 48 hrs Mean percent Percent of patients screened for dyspnea Mean percent If screened, percent that screened positive for dyspnea Mean percent If positive, percent treated within 24 hrs Mean percent Page 6 of 10

7 GOALS OF CARE If positive, percent with dyspnea improvement in 48 hrs Mean percent Chart documentation of Goals of care Mean percent Surrogate decision maker Mean percent Psychological or emotional needs Mean percent Spiritual concerns Mean percent Life sustaining treatment preferences Mean percent before initial consultation Mean percent after initial consultation Advance directive Mean percent before initial consultation Mean percent after initial consultation Do Not Resuscitate (DNR) Mean percent before initial consultation Mean percent after initial consultation Physician Orders for Life-Sustaining Treatment (POLST Mean percent before initial consultation Mean percent after initial consultation Percent of consults resulting in change in treatment plan Mean percent Of patients with full code, percent with status change Mean percent STAFFING Staffing model Embedded, program is internal to hospital Program is partially internal with some contracted services Program is administered by an outside contracted agency Total Staff Head Count (funded, in-kind and volunteer) Mean Head Count Median Head Count Minimum Head Count Maximum Head Count Physician (DO/MD) Mean Head Count Advanced Practice Nurse (APRN) Mean Head Count Physicians Assistant Mean Head Count Registered Nurse (RN) Mean Head Count Medical Residents Page 7 of 10

8 Mean Head Count Physician Fellows Mean Head Count Licensed Practical Nurse (LPN) Mean Head Count Psychologist Mean Head Count Psychiatrist Mean Head Count Social Worker Mean Head Count Chaplain/Spiritual Care Mean Head Count Physical/Occupational Therapist Mean Head Count Massage Therapist Mean Head Count Music/Art Therapist Mean Head Count Doula Mean Head Count Child Life Specialist Mean Head Count Dietician/Nutritionist Mean Head Count Pharmacist Mean Head Count Ethicist Mean Head Count Hospice Liaison Mean Head Count Medical Director (non-clinical time) Mean Head Count Administrative Support Mean Head Count Total Staff Full-time Equivalent (funded, in-kind and volunteer) Mean FTE Median FTE Minimum FTE Maximum FTE Physician (DO/MD) Mean FTE Advanced Practice Nurse (APRN) Mean FTE Physicians Assistant Mean FTE Registered Nurse (RN) Mean FTE Medical Residents Page 8 of 10

9 Physician Fellows Mean FTE Licensed Practical Nurse (LPN) Psychologist Psychiatrist Mean FTE Social Worker Mean FTE Chaplain/Spiritual Care Mean FTE Physical/Occupational Therapist Mean FTE Massage Therapist Music/Art Therapist Doula Child Life Specialist Dietician/Nutritionist Mean FTE Pharmacist Mean FTE Ethicist Hospice Liaison Mean FTE Medical Director (non-clinical time) Mean FTE Administrative Support Mean FTE Complete Interdisciplinary Team Physician, Nurse (APRN or RN), Social Worker, and Chaplain Program Lead Physician-led (1 FTE or more physician) Physician-led (Less than 1 FTE physician) APRN-led (No physician, at least 1 FTE APRN) APRN-led (No physician, less than 1 FTE APRN) RN-led (No physician, no APRN, at least 1 FTE RN) Workload Initial Consults per 1 FTE APRN or Physician Initial Consults per 1 FTE of Interdisciplinary Team Initial Consults per 1 FTE of all palliative care staff Palliative Care Certification Physician Page 9 of 10

10 Advanced Practice Nurse Registered Nurse Social Worker Chaplain Palliative Care Team Meetings Full team meets at least once a week Full team meets every other week Meetings are scheduled weekly, but not all team members attend Meetings are scheduled every other week, but not all team members attend Meetings are scheduled as needed on a case-by-case basis No formal meeting schedule Palliative Care Program Coverage Provides 24/7 coverage Not available 24/ STAFF RECRUITMENT Staffing Stability Stable - not recruiting or hiring Reduced staff in past two years - not currently recruiting Requesting/Recruiting additional staff Recruitment Type Recruiting clinical staff Recruiting non-clinical staff Requesting new staff lines for clinical staff Requesting new staff lines for non-clinical staff FUNDING Program Funding (Mean %) Ongoing Hospital Support Billing Philanthropy/Foundations/Grants Hospice Contracts Stipends Home Care Agency Not Funded Other % Hospital Support Page 10 of 10