(P45) Palliative Care Clinical Activation Report to Identify Palliative Needs

Objective/

Aim: To review the use of a Palliative Care Clinical Activation Report (PCAR©) to identify high-risk patients for a palliative care program.

Background: Development of internal palliative care programs in the Post-Acute Long-Term Care (PALTC) setting has been proposed as an answer to the unmet care needs in this population (Ersek et al., 2022). Our organization developed a palliative care program, with both generalist and specialist palliative care services. Nurse Practitioners (NPs) trained in palliative care provided clinical services to patients in 16 PALTC centers across 6 states.

Quality Improvement

Methods: Development of a Palliative Care Clinical Activation Report (PCAR©) was central to our ability to identify patients who may benefit from palliative care services. This report was developed in collaboration with our palliative care steering committee, and is based on data that already is in our electronic medical records. The report includes patients with recent hospital admissions and/or high-risk conditions including: Flacker score >/= 7, weight loss of 5% in 30 days or 10% in 6 months, falls, pressure injury, BMI < 20, and high-risk diagnoses (CHF, COPD, ESRD, or neurocognitive disorders). The report also provides information about the dates of the most recent hospital stay and advance care planning visit.

Results: Over 71% of the NPs who participated in this program strongly agreed or agreed with the statement that the PCAR© was easy to use. Over 57% of NPs strongly agreed or agreed that the report identified patients who were appropriate for palliative care services. Over a five month period, NPs performed 1070 palliative care visits and 1166 advance care planning visits in 16 centers as part of this program. A sample of the PCAR© will be included in the poster.

Conclusions: The development of the PCAR© was central to the identification of high-risk patients in our palliative care program. Use of this report by palliative-trained NPs was well received and clinically relevant. Our providers also receive requests for palliative care services by members of the interdisciplinary team, which may explain the nearly equivocal response for the report helping to identify patients appropriate for palliative care services. The PCAR© may be most useful in settings where a palliative care provider does not have strong interactions with the interdisciplinary team. Following the palliative care pilot program, this report was made available to all providers in our organization. Future work includes ongoing evaluation and refinement to maximize the utility of this report for the provision of impactful palliative care services.