Pro-active Palliative Care for Hospitalized Primary Care Patients

Early integration of palliative care (PC) improves outcomes for patients with cancer and heart failure. Data on the role of PC in complex general medicine patients is scant. We identified high-mortality risk patients from our primary care practice by screening with mortality indices upon hospital admission. We measured documentation of advanced care planning (ACP), including health care proxy (HCP) and goals of care (GOC), at admission and discharge. We offered pro-active PC consultation to attending physicians of patients with high mortality risk. Patients who received pro-PC consultation were compared to patients whose attending physicians declined consultation (pro-PC declined) as well as patients who received usual care (UC). Compared to UC and pro-PC declined groups, the pro-active PC group demonstrated increased rates of HCP and GOC documentation. Our initiative identified hospitalized primary care patients with high-mortality risk, improved gaps in ACP, and was feasible to implement.