COPD patients may benefit from increased access to palliative care

Nurse holding patients' hand in hospital setting.

Ordering a palliative care consultation by default — via an automatic order programmed into the electronic medical record that physicians can cancel if they choose — is an effective strategy to give more hospitalized patients the opportunity to benefit from palliative care sooner.

That’s according to a Perelman School of Medicine at the University of Pennsylvania study, which was published in the Journal of the American Medical Association.

By changing the process for ordering palliative care consultation from having doctors opt in and actively place an order to having the opportunity to opt out and cancel an automatic order, the study showed an increase in palliative care consultation rates from 16.6% to 43.9%. It also decreased the time to consultation by 1.2 days.

The study included more than 34,000 patients with COPD, dementia or kidney failure at 11 hospitals in eight states. Although palliative care consultation is recommended for many patients with serious illnesses, many more are not referred to palliative care or only receive a consultation at the end of life. Patients with COPD, dementia and kidney failure have been underrepresented in past studies on palliative care delivery, which have largely focused on patients with cancer or heart failure.

“While early palliative care consultation could help many patients with chronic serious illnesses better understand their diagnosis and align their treatment choices to their individual care goals, there has never been an established approach to realizing that goal at scale,” said lead study author Kate Courtright, MD, MS, assistant professor of critical care and palliative medicine. “We found that a simple, pre-programmed order within the electronic medical record can get more palliative care to more people more quickly. This strategy was low-cost and easily implemented in community hospitals, which is where most Americans receive their health care.”

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