Transcript National Consensus Project

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“The National Agenda to
Improve Care in Life
Threatening Illness”
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National
Consensus
Project
The Development of Clinical Practice
Guidelines for Quality Palliative Care
www.nationalconsensusproject.org
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National Consensus Project
Mission
To create a set of voluntary clinical
practice guidelines to guide the growth
and expansion of palliative care in the
United States
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What is the National
Consensus Project?
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Consortium of three key national palliative
care organizations:
• American Academy of Hospice and
Palliative Medicine
• Hospice and Palliative Nurses
Association
• National Hospice and Palliative Care
Organization
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Definition of Palliative Care
1. Aims to relieve suffering and to support the
best possible quality of life for patients with
advanced chronic or life-threatening illnesses
and their families.
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Definition of Palliative Care
2. Both a general approach to patient care
routinely integrated with disease-modifying
therapies, as well as a growing practice
specialty for highly trained specialist
physicians, nurses, social workers, chaplains
and others who work in teams.
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Palliative Care Ensures:
– Physical comfort through state-of-the art,
comprehensive management of pain and
symptoms
– Practical needs are addressed and
coordinated
– Psychosocial and spiritual distress is
managed
– Patient and family values and decisions are
respected and honored
– Opportunities are available for growth and
resolution
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Palliative Care is Important
“The nation is about to experience a great
demographic shock. Between 2010 and
2030 the over 65 population will rise over 70
percent.”
The Urban Institute, 1998
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Palliative Care is Important
• Americans:
– Increasingly experience chronic advanced
illness
– Suffer needlessly
– Need support in navigating the health
system
• Policy makers:
– Need effective solutions
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Palliative Care is Important
• Health care settings:
– challenged to deliver efficient and effective
management of long-term advanced illness
• Clinicians:
– Need support and expertise for treating
this growing population
QUALITY CARE TO THOSE WHO MOST NEED
IT, WHERE AND WHEN THEY NEED IT
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Where We Are Now
• Hospice has created “gold standard” of care
• Hospices are successfully expanding services
to provide palliative care to patients in a
variety of settings earlier in the course of
illness
• Leading hospitals and long-term care facilities
have started palliative care programs
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Where We Need To Go
• Expand access for patients and families
• Increase number of reliable, high quality
programs
• Assure quality
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Need Improved Outcomes
• Efficient, effective management of advanced
chronic and life-threatening illness
• Access
• Quality, including pain and symptom control
• Smooth transitions and case management
across health care settings
• Reduced variation among programs
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National Consensus Project
Structure
Phase I (2002 – 2004)
• Steering Committee – 20 members develop
draft document
• Advisory Committee – 100 nationally
recognized leaders across a variety of health
care settings, review and revise
• Liaison Organizations – 50 organizations with
major responsibility for health care of patients
with life-threatening illnesses, endorse and
disseminate the standards
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National Consensus Project
Structure
Phase II (2005 – 2006)
• Task Force – 10 members guide
dissemination process
• Advisory Committee – 34 national
leaders serve as a link to professional
organizations to disseminate the
guidelines
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Clinical Practice Guidelines
Consensus of the leading palliative care
organizations in the U.S., based on
1. Scientific evidence
2. Clinical experience
3. Expert opinion
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Clinical Practice Guidelines
• Facilitate development and improvement of
clinical programs, particularly those serving a
high proportion of people with acute and
chronically progressive conditions
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Clinical Practice Guidelines
• In the absence of organized programs or
specialists, guide clinicians to incorporate vital
aspects of palliative care into their practice to
improve care for their sickest patients, over
the course of their illnesses
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Clinical Practice Guidelines
• Establish accepted definitions of the essential
elements in specialist palliative care that
promote quality, consistency and reliability of
services
• Foster continuity of palliative care by
expanding access to case management
across settings
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NCP Goals
1. Build national consensus concerning the
definition, philosophy and principles of
palliative care through an open and inclusive
process that includes the array of
professionals, providers and consumers
involved in, and affected by, palliative care
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NCP Goals
2. Create voluntary clinical practice guidelines
for palliative care that describe the highest
quality services to patients and families
3. Broadly disseminate the clinical practice
guidelines to enable existing and future
programs to define better their program
organization, resource requirements and
performance measures
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NCP Goals
4. Help clinicians provide key elements of
palliative care in the absence of palliative care
programs
5. Promote recognition, stable reimbursement
structures and accreditation initiatives
through projects such as the National Quality
Forum (NQF)
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Clinical Practice Guidelines
8 Domains
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2.
3.
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5.
6.
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Structure and Process of Care
Physical
Psychological and Psychiatric
Social
Spiritual, Religious and Existential
Cultural
The Imminently Dying Patient
Ethics and Law
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Domain 1:
Structure and Process of Care
• Care starts with comprehensive
interdisciplinary assessment of patient and
family
• Addresses both identified and expressed
needs of patient and family
• Education and training are available
• Team is committed to quality improvement
• Emotional impact of work on team members
is addressed
• Team has relationship with hospices
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Domain 2:
Physical
• Pain, other symptoms and treatment side
effects are managed using best practices
• Team documents and communicates
treatment alternatives, permitting
patient/family to make informed choices
• Family is educated and supported to provide
safe/appropriate comfort measures to patient
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Domain 3:
Psychological and Psychiatric
• Psychological and psychiatric issues are
assessed and managed based on best
available evidence
• Team employs pharmacologic,
nonpharmacologic and complementary
therapies as appropriate
• Grief and bereavement program is available
to patients and families
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Domain 4:
Social
• Assessment (e.g. Family structure,
relationships, medical decision making,
finances, sexuality, caregiver availability,
access to medications and equipment)
• Individualized, comprehensive care plan
alleviates caregiver burden and promotes
well-being
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Domain 5:
Spiritual, Religious and Existential
• Assesses and addresses spiritual concerns
• Recognizes and respects religious beliefs –
provides religious support
• Makes connections with community and
spiritual/religious groups or individuals as
desired by patient/family
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Domain 6:
Cultural
• Assesses and aims to meet the culture-specific
needs of patients and families
• Respects and accommodates range of
language, dietary, habitual and ritual practices
of patients and families
• Team has access to/uses translation resources
• Recruitment and hiring practices reflect cultural
diversity of community
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Domain 7:
The Imminently Dying Patient
• Team recognizes imminence of death and
provides appropriate care to patient/family
• As patients decline, team introduces hospice
referral option
• Team educates family on signs/symptoms of
approaching death in a developmentally-, ageand culturally-appropriate manner
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Domain 8:
Ethics and Law
• Patient’s goals, preferences and choices are
respected and form basis for plan of care
• Team is aware of and addresses complex ethical
issues
• Team is knowledgeable about relevant federal
and state statutes and regulations
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Why adopt the
Clinical Practice Guidelines?
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Hospitals
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• Develop quality programs
• Efficiency: appropriate use of resources,
decreased hospital and ICU stays, lower costs
• Better clinical outcomes: relieves pain and
distressing symptoms in all stages of treatment
• Strengthened patient satisfaction: patients get
comfort care without forgoing other treatment
• Improved staff retention and morale: supports
doctors/nurses in care of complex patients
• Helps meet JCAHO quality and pain
management standards
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Nursing Homes
• Improved patient outcomes in accord with
regulations
• Meets patient and family needs
• Roadmap for caring for patients with chronic
illness
• Strengthened patient satisfaction: patients
get comfort care without forgoing other
treatment
• Improved staff retention and morale:
supports doctors/nurses in care of complex
patients
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Health Care Professionals
• Promotes optimal, evidence-based care to
your most complex, sick patients without
significant workload burden
• Better clinical outcomes: relieves pain and
distressing symptoms in all stages of
treatment
• Strengthened patient satisfaction: provides
the care patients want; improves
patient/family health care system experience
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Palliative Care Programs
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Ensures quality care
Guides program development
Ensures highest standards are met
Next step in maturing field
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Policy-makers
• Strengthens a health system that serves our
sickest patients
• More appropriate use of financial resources –
improved care while lowering costs
• Ensures that all patients and their families,
your constituents, receive a uniform and
appropriate level of care
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Patients and the Public
• Expert pain and/or symptom relief; helps end
needless suffering
• Everybody has a right to the best quality care
• Assistance in navigating the medical system
and choosing health care providers
• Guidelines are based on years of research
into best care for seriously ill patients
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National Consensus Project
Outcomes
The widespread adoption of these
guidelines in the U.S. will encourage a
level of consistency, comprehensiveness
and quality that patients and families
can come to expect whatever their
diagnosis, wherever they live,
regardless of the setting of care.
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What more can you do?
• Health care organizations: Use the
guidelines to start a palliative care
program for efficient, effective
management of your sickest patients
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What more can you do?
• Clinicians: Ask for a palliative care
program applying these guidelines in
support of your care; or, in the absence
of a program, use standards to provide
core elements to care of sickest patients
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What more can you do?
• Palliative care advocates: Champion
adoption and use of guidelines in your
organization & field and share with
colleagues
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What more can you do?
• Policy-makers: Create incentives for
health care organizations and providers
to adopt and practice clinical practice
guidelines
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What more can you do?
• Patients and families: Choose health
care organizations and providers who
have adopted clinical practice
guidelines, and ask for a palliative care
consult when you are facing advanced
chronic or life-threatening illness
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National Consensus Project
Voluntary Clinical Practice Guidelines
for Quality Palliative Care
For more information:
www.nationalconsensusproject.org