Virtual Palliative Care Is Inclusive Care (QI408)

OUTCOMES: 1. Describe a national virtual palliative care approach to increasing access to services for patients living with serious illness during the COVID-19 pandemic 2. Examine virtual palliative care utilization patterns in the inpatient and outpatient setting as well as the adoption of telephonic or video-based platforms 3. Recognize palliative care clinician perspectives and willingness to adopt virtual visits across the care continuum BACKGROUND: The number of Americans who are living with serious illness without adequate access to palliative care services is growing. Virtual palliative care offers an inclusive solution that enhances the patients’ quality of life and addresses complex patient centric needs. AIM STATEMENT: This project was developed during the COVID-19 pandemic to investigate telehealth utilization and engagement as well as clinician perceptions and experiences using the virtual platform. METHODS: We evaluated the use of telephone and video visits in 7 states from May 2020 to April 2021. Of the 84 palliative care clinicians (physicians and APPs) practicing in those states, 35 clinicians (42%) conducted virtual visits. A total of 1,816 virtual visits were completed based on claims analysis. We conducted a clinician experience survey that was completed via Google forms by 15 physicians (44% response rate), which provided qualitative feedback. RESULTS: Of the 1,816 visits completed, 332 were telephonic and 1,484 video. 30% of the visits were from the inpatient setting, 19% nursing facility, and 51% outpatient. Top diagnoses were respiratory failure, neuro/Parkinson's, dementia, CHF, and cancer. 37% of the patients lived in disadvantaged zip codes. 93% of the clinicians who responded to the survey were open to having a video visit with their patients with reported benefits such as improved access to care, more efficient use of time, and enhanced clinician-patient relationship. The barriers reported by clinicians included patients having limited availability to a device with a camera and inadequate internet bandwidth. CONCLUSIONS AND IMPLICATIONS: Clinicians find virtual palliative care to be beneficial to patients for goals-of-care conversations, frequent symptom assessment, and engaging multiple family members. Despite a perception that video visits have low adoption in older populations, more than 68% of the virtual visits were with patients 65 years+. These findings have strong implications for clinical practice transformation and further study in the field of virtual palliative care.