| Description |
Background: The Veterans Health Administration has made significant improvements in end-of-life care, including an increase in hospice utilization. Timely referrals to hospice care are crucial for improving the quality of life for terminally ill Veterans. The primary care setting is an ideal place to initiate these referrals and improve overall hospice utilization among Veterans. Local Problem: The Salt Lake City Veterans Affairs Medical Center (SLC VAMC) places fewer hospice referrals in outpatient settings compared to other VAMCs in the same service network, which negatively impacts quality metrics tracked by the Department of Veterans Affairs (VA). Therefore, the purpose of this needs assessment was to identify barriers to hospice referral in outpatient primary care clinics operated by the SLC VAMC and develop evidence-based strategies to address identified barriers. Methods: To identify barriers, a mixed-methods approach consistent with Lean methodology was used to collect data from primary care providers, registered nurses, and social workers, using a questionnaire and one-on-one interviews to develop process maps. The data was reviewed, and interventions were developed by a focus group that met seven times between September 2022 and December 2022. The findings and recommendations of the project were presented to healthcare partners in an executive report and live presentation, and their feedback was obtained using a satisfaction, usability, and sustainability questionnaire. Results: A questionnaire response rate of 11.2% (30/266) was achieved, and six process maps were created from one-on-one interviews. Our findings suggest low hospice referral rates at the SLC VAMC may result from inadequate training, communication, proactive patient identification, and resource utilization. To address these barriers, interventions were recommended, including the creation of a palliative care resource flowchart, a palliative care SharePoint webpage, and an education module aimed at increasing primary care staff's knowledge of palliative, hospice, and concurrent care. The satisfaction, usability, and sustainability questionnaire provided valuable feedback to ensure the successful implementation and sustainment of these interventions. Conclusion: Our needs assessment identified barriers to hospice referral in outpatient primary care operated by the SLC VAMC, and we developed evidence-based interventions to address them. The palliative care resource flowchart, SharePoint webpage, and education module are recommended interventions to facilitate early identification of potential hospice candidates, increase communication and resource utilization, and sustain long-term improvements. Healthcare partners expressed significant support for advancing the recommended interventions into phase II, which will involve their implementation and tracking. |
