Health Literacy and Palliative Care Workshop Summary (2016) / Chapter Skim
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2 Communication: Palliative Care's Transformational Procedure
2 Communication: Palliative Care's Transformational Procedure
Pages 5-16
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From page 5... ...
"Spending money on very sick people is not waste," Meier emphasized. "How we spend that money is a different question, but conflating high spending with waste should stop." Health care spending data show that 1 percent of patients, the sickest and most vulnerable, account for 25 percent of all spending, and 5 percent of patients account for 50 percent (Schoenman 1 This section is based on the presentation by Diane Meier, Director of the Center to A dvance Palliative Care (CAPC)
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As an example of an illiterate health system, Meier recounted the story of Mr. B., an 88-year-old man with dementia who was admitted to the emergency department for management of back pain resulting from spinal s tenosis and arthritis.
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There were loose throw rugs everywhere, electrical wires crisscrossing the floor, no grab bars in the bathroom, no elevated toilet seat, and the only thing in the refrigerator was leftover Chinese food. "Why was that?
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"Being old plus caregiver exhaustion are driving his utilization," said Meier. Health systems, she said, should be screening patients for palliative care using criteria that include functional limitation, frailty, dementia, exhausted and overwhelmed family caregivers, and social and behavioral health challenges, and she noted that data from the Medicare Current Beneficiary Survey support these criteria (see Figure 2-2)
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From page 9... ...
TABLE 2-1 Use of Health Services by Medicare and Medicaid Patients with and Without Dementia Dementia No Dementia Medicare SNF use 44.7% 11.4% Medicaid NH use 21% 1.4% Hospital use 76.2% 51.2% Home health use 55.7% 27.3% Transitions 11.2% 3.8% NOTE: NH = nonhospital; SNF = skilled nursing facility. SOURCE: Presented by Diane Meier on July 9, 2015.
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From page 10... ...
Enormously," said Meier. "If we stick to prognostic criteria, we are missing the boat." Palliative care is provided by an interdisciplinary team that works with patients, families, and other health care professionals to provide an added layer of support, Meier explained.
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From page 11... ...
To illustrate the power of palliative care in the home setting, she cited a randomized controlled trial from Kaiser Permanente in which patients with heart failure, COPD, or cancer were enrolled in either a home palliative care intervention or usual Medicare home care. Though the patients in the palliative care intervention received more home visits, they required fewer physician office visits, used the emergency department less, were hospitalized less, and spent fewer days in skilled nursing facilities (Brumley et al., 2007)
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From page 12... ...
The place where health literacy is most involved, explained Meier, is in goal setting, which requires asking the person and family what is most important to them, and she told the stories of four of her patients to illustrate this point. The first story was that of Mr.
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Though she still had brain activity, she had spent 6 months on a ventilator receiving TPN and had developed the worst pressure ulcers anyone on staff had ever seen. Her three adult children visited regularly, frequently coming to blows in the intensive care unit (ICU)
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"How is the health care system designed? " asked Meier.
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She applauded the American Cancer Society for running a series of ads that illustrate the importance of palliative care. These ads, she said, convey the central idea that palliative care sees the person beyond the cancer treatment and gives the patient control, and they make the point that palliative care represents a big shift in focus for health care delivery that works to improve the lives of patients.
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