Franciscan Health System - End of Life Program
Franciscan Health System's Improving Care through the End of Life Program supports patients identified by their primary care physician as being at risk for dying within one to two years. A team including a clinic nurse care manager, a chaplain, a volunteer coordinator and volunteers work within specific clinics to support and educate these patients.
Situation
Patients with end stage chronic diseases and at risk for dying are falling through the cracks, are not connected with helpful community resources and do not have the support system they need to make informed and value based decisions regarding healthcare choices for the end of their lives. Because of this, they are often unable to avoid unnecessary or unwanted emergency room visits and/or costly hospitalizations. Advance Directives are either not completed and/or are not honored. Hospice care is the "gold standard of end-of-life care" and is available to virtually all dying patients but is underutilized.
Solution
Franciscan Health System's Improving Care through the End of Life Program supports patients identified by their primary care physician as being at risk for dying within one to two years. A team including a clinic nurse care manager, a chaplain, a volunteer coordinator and volunteers work within specific clinics to support and educate these patients. Volunteers contact patients and caregivers at least once a month to learn of any new issues or concerns and to help alleviate social isolation. Patients and their caregivers are held within a "safety net" until Hospice is appropriate, desired and ordered by the physician. Patients that stabilize and are discharged off Hospice are taken back onto the end-of-life program to assure continuity of care. Readmit to Hospice then takes place when it is again appropriate, desired and ordered.
Better Health & Lower Costs
Patients, caregivers and physicians report a satisfaction level of 99% with the extra support and education offered by the program staff.
Fifty-six (56) providers have taken eight hours of Continuing Medical Education (CME) specific to end-of-life care in order to be able to admit their patients to the Improving Care through the End of Life Program.
Currently 10 clinics in Pierce County and South King County of Washington State, offer the program to their patients. A total of 753 patients are being supported at this time. Patients and family caregivers are offered spiritual support resulting in 1,428 chaplain contacts in fiscal year 2003.
For every $1.00 Medicare spends on Hospice, it saves $1.50, so Hospice is always going to be not only "better" end-of-life care but more cost effective care. Hospice utilization for the patients on the end-of-life program is 71% as compared with 25% nationally. The Hospice average and median length of stay for patients on the program is double (101.8 and 44.5)the national average and median (48.0 and 25.0) indicating that patients on the program choose their Hospice option rather than seek additional, futile and/or expensive diagnostic and treatment options. Early support and education are the key factors in patients and caregivers choosing Hospice in a timely manner.
Currently 72 volunteers help support the program by calling and checking on patients at least monthly. Patients and caregivers are thrilled "someone cares enough to call from their Doctor's office!"
