Monday, August 24, 2015

Building high quality and lasting hospice programs in rural areas

by John M. Saroyan

Vermont is the sixth smallest in area and the 2nd least populous of the fifty United States. Medicare data from 2013 show that Vermont had among the lowest hospice penetrance rates in the country along with New York, Wyoming, South and North Dakota, and Alaska. While enrollment in hospice has been associated with improved survival for CHF, colon, lung and pancreatic cancer, improved quality of care for persons dying of dementia, and improved mortality outcomes in surviving widowed spouses, I find knowledge of these research findings to be low. And while a sense of comfort and relief for millions of Americans is provided by hospice every year, it is frequently felt to be a service for the imminently dying.

Since beginning my role as Hospice Medical Director for BAYADA Home Healthcare in Vermont and New Hampshire in 2013, I have spoken with health care providers of many disciplines in the region about why hospice utilization may be so low. Hospice practice in rural and remote areas is captured in population based data that can be broken into counties but is poorly represented in hospice and palliative care literature. Its day to day challenges and successes are learned from actual and shared experience.

This #hpm chat encompasses an international group of participants who bring a diversity of experience to the topic of building high quality and lasting hospice programs in rural areas. My aim is to pose questions that will lead us to common ground for building these programs in order to meet the end-of-life needs of our patients, families as well as hospice clinical and administrative staff.

Questions that will be posed during #hpm chat:
  • How is access to hospice care a barrier for patients and families where you live?
  • How is the availability of experienced staff a barrier?
  • Have prescription monitoring programs or pharmacy dispensing practices interfered with your ability to dispense opioids?
Dr Saroyan (@jmsaroyan) is the full-time Hospice Medical Director for BAYADA Home Health Care. He also holds faculty appointments at Geisel School of Medicine, UVM Medical Center, and Columbia University.

What: #hpm chat on Twitter
When: Wed August 26, 2015 - 9p ET/ 6p PT
Host: Dr. John M. Saroyan (@jmsaroyan)

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Image credit: Vermont Hogback Mountain via Wikimedia (CC license)

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