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MASSC Survey – Program Leaders Mellar P. Davis M.D. FCCP FAAHPM.

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Presentation on theme: "MASSC Survey – Program Leaders Mellar P. Davis M.D. FCCP FAAHPM."— Presentation transcript:

1 MASSC Survey – Program Leaders Mellar P. Davis M.D. FCCP FAAHPM

2 Format Questions 4-25, 39, 44, 49, 51, 54-60, 62-65 pertain to all programs. Questions 26-38 pertain to programs with dedicated (non- hospice) acute care beds. Questions 40-43 pertain to programs with a dedicated consultation service. Questions 45-48 pertain to programs that see patients in an outpatient setting

3 Format Question 50 pertains to programs that have a hospice program. Questions 52-53 pertain to programs with palliative medicine fellowship programs. Question 61 pertains to programs that have palliative care grand rounds. Questions 66-81 pertain to programs that have a research program. Note that questions 76-81 appear to pertain to all programs however question 65 ends the survey if the program does not conduct research.

4 Results 62 program leaders completed the survey Program names were most often described using a single phrase (Question 2) – “Palliative care”, 22/61 (36%) “Comprehensive cancer care”, 5/61 (8%) “Pain and symptom management”, 3/61 (3%) “Supportive care” 2/61 (3%) An unlisted phrase,5/61 (8%) 39% of programs were described using two or more phrases

5 Results The majority of programs were recorded as being more than five years old (43/61, 70%); 3 (5%) were recorded as being less than one year old; 4 (7%) as being 1-2 years old, and 11 (18%) as being 3-5 years old. Responses are reported for all leaders combined and broken down by whether the program is relatively new ( 5 years old).

6 What are the specific kinds of palliative care services that are available? What are the type (s) of services that your palliative care team offers?

7 Results Other than in-house hospice the majority of programs offer all of the services described in questions 4 and 5, with 49% of programs offering consultation/mobile team service, supportive care clinics, and dedicated PC acute care beds (Q4); 59% of programs offered 7-8 of the specific services listed in Q5

8 Approximately, what proportion of patients seen by palliative care belong to the pediatric age group (<18 year old)?

9 Results Approximately 1/3 (34%) of programs see pediatric patients

10 What is the professional background of the palliative care program leader?

11 Results The professional background of program leaders is quite varied. The most commonly recorded specialty was medical oncology (74%). 69% of respondents recorded >1 specialty

12 Within your program, please indicate the approximate number of paid personnel assigned to palliative care

13 Results 48% of programs reported having >5 ward (inpatient) nurses assigned to PC; 10% reported having >5 clinic (outpatient) nurses assigned to PC The majority of programs have at least one chaplain, dietitian, mid-level provider, rehabilitation personnel, psychologist, and social worker assigned to PC, but no pharmacists or psychiatrists

14 Approximately, how many full-time equivalent (FTE) physician positions are available in your palliative care program? Approximately, how many physicians on your palliative care team have at least 20% academic protected time? Does your palliative care program require physicians to be certified (finished a fellowship and taken boards)? Does your palliative care program require nurses to be certified (taken boards in palliative nursing)?

15 Results Programs reported a median (range) of 2 (0-15) FTE physicians available for PC; over half (55%) the programs reported that at least some physicians have >20% academic protected time The majority of programs (58%) required physicians to be certified (finished a fellowship and passed boards) and 53% required nurses to be certified

16 On average, how long does your palliative care team follow patients in your institution (all inpatient and outpatient encounters)?

17 Results 43% of programs followed patients throughout the course of their illness

18 Does your palliative care program have any dedicated acute care beds in your institution

19 Results Almost 3/4 (74%) of programs reported having dedicated (non-hospice) acute care beds; median (range) number of beds - 10 (0-43) Almost 3/4 (74%) of these programs had a designated PC unit Within these programs the median (range) number of inpatient discharges/month was 24 (2-250); and the median length of stay was 10 days (range 3-98)

20 Results The median (range) inpatient PC mortality rate within these programs was 40% (2-99%) Acute symptom management was the primary reason for admission. Program leaders reported a median of 60% (range 0-90%) of admissions were for symptom management The primary referral sources were outpatient clinics (median 25%; range 0-90%)), and inpatient units other than intensive care (median 20%; range 0-100%)

21 Results >75% of patients received regular psychosocial assessments on each admission in 55% of programs; >75% of patients had family conferences in 50% of the programs; Oncologists attended >75% of family conferences in 36% of programs; >75% of patients had standing DNR orders in 51% of programs

22 Does your palliative care program have a dedicated consultation service in your institution?

23 Results The vast majority (92%) of programs had dedicated consultations services The service was available 24/7 in 43% of programs A median (range) of 25 (3-400) referrals were made to the service monthly The most common referral sources were medical and radiation oncology, and surgery

24 Does your palliative care program see patients in the outpatient setting?

25 Results 90% of programs saw patients in an outpatient setting (primarily dedicated PC units) Outpatient clinics were held a median (range) of 5 (0.5-7) days a week and a median (range) of 30 (3- 250) referrals/month were made to it Similar to consultation services the most common referral sources were medical and radiation oncology, and surgery

26 Does your institution operate a hospice?

27 Results 23% of programs operated a hospice

28 Fellowship program for Palliative Medicine?

29 Results A little over 1/3 (37%) of programs had a fellowship program for palliative medicine. Most of these programs (52%) had 1-2 clinical fellows/year; 56% had 1-2 research fellows/year

30 Mandatory palliative care rotations for…

31 Results When applicable the majority of programs (56%) required PC rotations for medical oncology and hematology fellows; 33% required them for radiation oncology fellows; 9% required them for pediatric oncology fellows; 51% required them for other fellows/residents; 35% required them for medical students

32 Training of mid-level providers in palliative care

33 Results Most programs (61%) trained mid-level providers

34 Dedicated palliative care grand rounds

35 Results A little over 1/2 the programs (53%) held PC grand rounds – 68% held 1/week and 32% held 2-3/week

36 Length of training for fellows for certification

37 Results Slightly less than 1/2 the programs (48%) had recognized accreditation requirements in order to be recognized as a PC specialist

38 Is there a research program in palliative care

39 Results 64% of leaders reported having a PC research program The research team most frequently consisted of physicians (100%), data analysts (75%), research nurses (72%), and/or psychologists (56%). 44% of the teams were fully staffed in the sense that they consisted of physicians, data analysts, research nurses and psychologists/social workers + other personnel

40 Results 62% of the research programs received outside funding – primarily from private foundations and philanthropy 86% of programs conducted prospective studies, 57% conducted retrospective studies, 51% reported case series/reports, and 54% conducted qualitative studies

41 Results Research programs reported their results in PC and oncology journals, as well as more general medical journals (70% of programs had at least one publication in a PC journal last year; 68% had at least one in an oncology journal; and 49% had at least one in a general medical journal)

42 “Young” versus “Mature” Programs The number of newer programs is relatively small and therefore comparisons need to be viewed cautiously Several differences that are perhaps worth noting include:

43 “Young” versus “Mature” Programs The professional backgrounds of the leaders from younger programs tended to be oncology based (medical/radiation oncology) more frequently than those of mature programs Among programs with dedicated acute care beds length of stay tended to be shorter in mature programs compared to younger programs (median (range) 9.5 (3-96) versus 14.5 (9-98) days, respectively, p=007)

44 “Young” versus “Mature” Programs Among programs with dedicated consultation services mature programs tended to have more referrals/month than younger programs (median (range) 30 (3-400) vs 15 (4-40), respectively, p=.04); however this may be an artifact of the size of the programs? Mature programs tended to require PC rotations for non-oncology fellows and residents more frequently than younger programs (60% vs 20%, p=.04); however this could be an artifact of the type of PC programs in each group?

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