Implementing Strategies to Increase Referrals From Home Health to Hospice

ABSTRACTMeagan Sutton: Implementing Strategies to Increase Referrals from Home Health to Hospice (Under the direction of Rebecca Kitzmiller)Although hospice care is associated with greater rates of moral support, consistent care, comfort, and peace during end of life in comparison to home health, only 12-15% of all Medicare eligible recipients receive hospice care. Without hospice services patients and families may experience undue burden related to unmanaged symptoms, fear, anxiety, isolation, and loneliness associated with terminal illness. Conversely, when in hospice, patients experience improved pain assessment and symptom management, better bereavement outcomes and overall satisfaction, and lower mortality rates among family members of patients who received hospice care. While recent studies about barriers to hospice are lacking, knowledge deficit, lack of training, provider attitudes and poor patient knowledge, may contribute to low rates of hospice referral. This quality improvement project aimed to improve identification of hospice-eligible patients and increase hospice referrals for Medi Home Health and Hospice patients using three strategies: education, electronic screening and regular communication. Education and support tools were created and then provided to all 29 home health staff and five leadership members during a face-to-face education session using a presentation and supported by handouts. Each week, the hospice director and home health director collaboratively reviewed patients identified through an electronic health record tool to determine readiness for hospice and potential transfer from home health. From among patients receiving home health care, 19 were identified as hospice eligible. Out of the 19 patients, 15 were admitted to hospice services and four declined hospice services. A key concern for Medi Home was the observation that many patients died within a short period of time following admission to hospice, thus they received little benefit from services. Patients who receive hospice care throughout a longer length of stay, experience more comprehensive benefits for themselves and their families to include symptom management, emotional, spiritual, and psychosocial support, better bereavement outcomes, and reduced family burden. As found in this project, there often are patients on or about to be discharged from home health services who meet all the eligibility criteria for hospice.