Iowa Health System Leadership Symposium. Palliative Care and Hospice The “Final” Frontier. “I am not Dr. James Bell”. Palliative Medicine (IHS Affinity Group ).
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Palliative Care and Hospice
The “Final” Frontier
Palliative Medicine is a medical specialty that provides comprehensive, interdisciplinary care for patients with serious illnesses (and their families) with emphasis upon the quality of life and relief of suffering. Palliative Care is provided throughout the trajectory of a disease process without regard to prognosis and can be provided in concert with curative care, as well as near end of life. The Palliative Care team works with patients in conjunction with their primary care physician to address any physical, psychosocial, emotional or spiritual issues the patient may experience.
Pulling the plug
Stopping aggressive therapies
A very good name for what we do
Total health care costs in 2008 of $2.4 trillion (16% of GNP, rising to 20% in 2015)
Medicare hospital expenditures
2001: $93 billion (39% of total)
2004: $136 billion (44% of total)
2009: $220 billion (44% of total)
27-30% of total Medicare budget consumed in last year of life
Medicare Hospice expenditures 2008-- $11.4 billion (3% of total Medicare budget)
Population over 85 will double to 10 million by 2030
20% of U.S. population will be over 65 by 2035
U.S.– 53% die in hospital (not where they want)
With predicted 6 month survival of 50/50, 38% spend >10 days in ICU and 10% spend 4 weeks in ICU
50% of patients report moderate or severe pain at least half of the time in the last three days of life
Source: SUPPORT investigators, JAMA 1995
USA has poor ratings on quality measures of health care among industrialized countries (40th overall, 27th in life expectancy)
National Quality Forum www.qualityforum.org
Institute for Healthcare Improvement