To help clinicians understand when palliative care orders might be most appropriate, Ascension Health is participating in an National Institutes of Health-funded study run by University of Pennsylvania researchers to evaluate electronic health record-prompted automation of palliative care consult orders in the acute care setting.

The partnership will enable the Penn researchers and care teams at 11 Ascension facilities to ascertain when, based upon criteria in the EHR, palliative care consult orders can be considered the default.

The study will look at patients with end-stage renal disease who are on dialysis; patients with COPD who are either oxygen-dependent or who have been hospitalized two or more times in a 12-month span; and patients with advanced dementia admitted from a long-term care facility or prior placement of a surgical feeding tube or two or more additional hospitalizations in the past 12 months.

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Lynn Hollar, senior clinical analyst lead for Ascension Information Services Clinical Information Systems and Ascension data architect Suzanne Parra will present the goals of the study, Palliative Care: Using the EHR for Patient Care, at HIMSS16 in Las Vegas next month.

"When we started looking at this, there was really nothing in an EHR that was an algorithm like we developed that said 'Identify this patient as being eligible for palliative care,'" she said.

Yet, quantifying some of the factors that may determine whether palliative care is indicated can be particularly vexing for clinicians and, what’s more, palliative care is often mistakenly overlooked entirely.

Hollar explained that a patient who may benefit most from palliative care could be someone in their 30's, for instance, with end stage renal disease, waiting for a transplant, who would like to be able to avoid hospitalization whenever possible. Another good candidate may be a patient who would like to find a way to relieve the burden on a spouse who has to schedule their lives around thrice-weekly dialysis trips. Utilizing palliative care to decrease their re-hospitalizations, avoid transfers to the ICU, and decrease the number of tests ordered may not only improve their quality of life, but also might offer cost reductions while not deleteriously affecting care.

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Hollar said the new default opt-out protocol will be implemented at the first participating study facility April 1, with additional hospitals coming in at regular intervals. And, although the study itself is confined to the three delineated conditions, Hollar said the process by which the determining algorithm was constructed – and by which providers were educated about when palliative care might be a wise decision – has already borne fruit.

"Our criteria right now are very specific because of the study, but when this study is done, and for similar facilities not in the study, we are going to start with this base and build it out and include a lot of other diagnoses and pieces of care we know now will work,” she added.

Hollar and Parra will be presenting their data 2:30 p.m. March 1 at the Sands Expo Convention Center, Palazzo G.

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