High specialist palliative care reach (mean facility rate 32.7%) among advanced heart failure patients was linked to above-average team staffing, cardiology-initiated consults, and outpatient care.
Cohort
Yes
What facility-level factors are associated with high rates of specialist palliative care delivery for patients with advanced heart failure across VA medical centers?
High reach of specialist palliative care in advanced heart failure is driven by modifiable facility-level factors including staffing, cardiology involvement, and outpatient palliative care availability.
BackgroundPalliative Care (SPC) is a guideline-recommended intervention for people with advanced heart failure (aHF). However, there is wide variation in delivery across VA medical centers (VAMCs). This study sought to identify key difference-making features that distinguished VAMCs with high vs lower rates of specialist palliative care (SPC) among this population.MethodsWe conducted a secondary analysis of data from the HEART-PAL cohort, comprising 78 high-complexity VAMCs. We used Coincidence Analysis (CNA) to identify minimally necessary and sufficient conditions associated with high (top 25%) or lower (bottom 75%) rates of SPC. Candidate conditions included structures (ie, full-time equivalents (FTE)) and processes (providing outpatient care), as well as cardiology and facility characteristics.ResultsFacility-averaged rates of SPC across VAMCs were 32.7% (standard deviation (SD) = 16.28). We identified 3 pathways to attaining high rates of SPC: above average total team FTE (top 50%) with high numbers of cardiology-initiated consultations (top 25% of consults) OR above average FTE with high use of outpatient palliative care (top 25% of encounters) OR a lower complexity VAMC with above average use of chaplaincy services (Top 50% of visits). In the negative model, there were 2 pathways to having SPC rates in the bottom 75%: below-average team total FTE, OR the absence of high cardiology-initiated consultations, together with the absence of high outpatient consultations.ConclusionHigh SPC reach among people with aHF was linked to combinations of several modifiable factors related to staffing, cardiology involvement, and outpatient palliative care. These findings provide actionable insights into improving SPC delivery across VAMCs.
Zhan et al. (Sun,) conducted a cohort in advanced heart failure (aHF). Factors associated with high rates of specialist palliative care vs. Factors associated with lower rates of specialist palliative care was evaluated on High (top 25%) or lower (bottom 75%) rates of specialist palliative care (SPC). High specialist palliative care reach (mean facility rate 32.7%) among advanced heart failure patients was linked to above-average team staffing, cardiology-initiated consults, and outpatient care.