Background: Hospice care is underutilized despite its proven benefits for patients with chronic conditions. Early goals of care conversations improve hospice enrollment and end-of-life outcomes. Bloom Healthcare is a home-based primary care practice serving older adults with multiple chronic conditions.
Problem: Bloom Healthcare has insufficient identification and under use of hospice services for eligible patients with chronic conditions. This gap leads to unnecessary hospitalizations, high costs, and suboptimal end-of-life experiences.
Methods: Using the SQUIRE guidelines, this quality improvement project implemented a prognosis screening tool in post hospital discharge follow up visits to identify older adults at high risk of mortality and re-hospitalization (n = 973). Providers used the prognosis tool to guide goals of care conversations and recommend hospice, when appropriate. The intervention involved three Plan-Do-Study-Act (PDSA) cycles: adapting the tool, written provider education, and video provider education with distribution of a hospice reference pamphlet.
Results: Hospice admissions increased from 18.5 % to 20.3 %, meeting the primary aim. The average hospice length of stay declined from 30.5 days to 13 days, outcome measure two. ER/hospitalization rates were not statistically significant, p = 0.98, process measure one. Goals of care conversations reached 71.3 %, process measure two. Provider survey responses indicated support for the tool, process measure three. Nurse Care Managers reported 2.36 minutes on average to complete the prognosis tool per patient, significantly below the 15-minute goal, balancing measure one.
Conclusions: The prognosis screening tool effectively facilitates timely hospice admissions and goals of care conversations in home-based care settings, enhancing end-of-life care and patient centered outcomes.
Keywords: Home health; Hospice; Older adults; Prognosis tool; Quality improvement.
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