Four Seasons, Flat Rock, North Carolina 28731, USA.
J Pain Symptom Manage. 2012 Dec;44(6):797-809. doi: 10.1016/j.jpainsymman.2011.12.278. Epub 2012 Jul 7.
In the U.S., the number of hospital-based palliative care programs has increased rapidly, but availability of outpatient palliative care remains limited. Multiple barriers impede the financial viability of these programs. Four Seasons, a nonprofit organization in western North Carolina, delivers a full spectrum of palliative care in hospitals, nursing homes, assisted living facilities, patients' homes, and outpatient clinics; its catchment area encompasses approximately 350,000 people. Initially focused on hospice care, Four Seasons added its palliative care program in 2003. Before the inquiry described herein, financial losses from outpatient palliative care (2003-2008) were escalating.
We explored organizational and financial barriers to sustainability of palliative care, so as to 1) identify reasons for financial losses; 2) devise and implement solutions; and 3) develop a sustainable model for palliative care delivery across settings, including the outpatient setting.
In 2008, Four Seasons's palliative care program served 305 patients per day (average) with 10.5 providers (physicians, nurse practitioners, and physician assistants); financial losses approached $400,000 per year. We used Quality Assessment and Performance Improvement cycles to identify challenges to and inefficiencies in service provision, developed targeted strategies for overcoming identified barriers to cost-efficiency, instituted these measures, and tracked results.
In 2011, Four Seasons served 620 palliative care patients per day (average) with 14 providers; financial losses decreased by 40%.
With health care reform promoting integration of care across settings, outpatient palliative care will gain importance in the health care continuum. Process changes can help reduce financial losses that currently impede outpatient palliative care programs.
在美国，医院姑息治疗项目的数量迅速增加，但门诊姑息治疗的可及性仍然有限。多种障碍阻碍了这些项目的财务可行性。北卡罗来纳州西部的一个非营利组织四季公司在医院、养老院、辅助生活设施、患者家中和门诊诊所提供全方位的姑息治疗；其服务范围约为 35 万人。四季公司最初专注于临终关怀，于 2003 年增加了姑息治疗项目。在本文所述调查之前，门诊姑息治疗的财务损失（2003-2008 年）一直在不断加剧。
我们探讨了姑息治疗可持续性的组织和财务障碍，以便：1）确定财务损失的原因；2）设计和实施解决方案；3）为跨环境（包括门诊环境）的姑息治疗提供制定可持续模式。
2008 年，四季公司的姑息治疗项目每天为 305 名患者（平均）提供服务，有 10.5 名提供者（医生、护士从业者和医师助理）；每年接近 40 万美元的财务损失。我们使用质量评估和绩效改进周期来确定服务提供方面的挑战和效率低下的问题，制定了针对成本效益障碍的有针对性的策略，实施了这些措施，并跟踪了结果。
2011 年，四季公司每天为 620 名姑息治疗患者（平均）提供服务，有 14 名提供者；财务损失减少了 40%。
随着医疗改革促进了跨环境的护理整合，门诊姑息治疗将在医疗保健连续体中变得更加重要。流程的改变有助于减少当前阻碍门诊姑息治疗项目的财务损失。
