NEEDS-PC Trial Aims to Improve Access to Palliative Care Services for Seriously Ill Patients.

In partnership with the University of Pennsylvania’s PAIR Center, the NEEDS-PC Trial will investigate a novel approach to identifying patients with serious illnesses who could benefit from palliative care services, thereby ensuring they receive this additional support.

Palliative care is a specialty focused on providing healing relief and comfort to patients living with serious illnesses, providing an extra layer of support for caregivers and providers who are working to manage their symptoms and ensure the patient’s care is aligned with their individual goals. Unlike hospice, which people often associate with end-of-life care, palliative care can benefit people of any age and at any stage of a serious illness. 

Too often, however, patients don’t receive palliative care services in a timely manner.

We’ve partnered with the University of Pennsylvania’s Palliative and Advanced Illness Research (PAIR) Center to launch the Nudging Effective and Equitable Delivery of Specialty Palliative Care (NEEDS-PC) Trial, a study designed to explore ways to identify patients who could benefit from palliative care services earlier in the disease process and help them access these services.

MedStar Health Research Institute is developing and fine-tuning a complex algorithm that analyzes a patient’s electronic health record for several aspects of health to identify whether they could benefit from palliative care. While existing palliative care alert systems at some hospitals detect only signs of health deterioration or prognosis, our algorithm considers characteristics that describe the need for palliative care, such as:

• Diagnosis of a serious illness 

• Ability to function independently in day-to-day life

• Recent healthcare utilization, including frequent Emergency Department visits or multiple hospital admissions, can indicate declining health

• Symptom management needs, such as uncontrolled pain and shortness of breath

These criteria can help provide a more comprehensive view of the patient’s condition, enabling providers to assess who needs extra support accurately. 

MedStar Health is a national leader in palliative care. We formed our first grassroots palliative care team in 2003, and after demonstrating positive outcomes, MedStar Health invested in expanding palliative care throughout the MedStar Health system in 2014. Our interdisciplinary teams include doctors, advanced practice providers, pharmacists, social workers, chaplains, and nurses. Together, we help care for patients and their families at any stage of serious illness. 

The NEEDS-PC Trial will help us learn how best to use the technology we’re developing to deliver palliative care to patients who need it early on, when it’s most beneficial. 

Exploring ways to improve access to palliative care.

The NEEDS-PC Trial employs a stepped-wedge cluster randomized trial design, or phased approach, to explore two methods of enhancing patient access to palliative care services. We expect to enroll approximately 18,000 patients over the next two years. 

Each of MedStar Health’s nine acute care hospitals will implement three phases of this trial over the course of the study period to better understand how alerts within the electronic health record can reduce barriers for eligible patients to receive palliative care, without interfering with standard clinical decision making for our hospital-based physicians.

Our goal is to determine whether the opt-in or opt-out method can increase equitable access to palliative care consultations, thereby improving patient-centered outcomes. 

To provide even more helpful information, the NEEDS-PC Trial will include a qualitative component and survey data. We’ll talk with patients, caregivers, and providers about their experiences with palliative care to help us understand how providers interact with EHRs, why they might choose to opt out of the consultation, and other decision-making factors that will help us improve serious illness care for everyone. We are also launching a system-wide survey to assess understanding and perceptions of palliative care across our large health system. 

Related reading: Research: Earlier Palliative Care Improves Patient Outcomes in the Cardiac ICU.

Palliative care benefits patients, families, and hospitals.

At least 13 million people in the U.S. live with a serious illness. Yet as many as 66% of patients who need palliative care don’t have access to these services for their physical, emotional, and spiritual health. 

A recent poll shows that 95% of respondents believe that educating patients and their families about palliative care is essential once they understand what it entails. Additionally, 90% said they would consider palliative care for themselves or a loved one facing a serious illness. The NEEDS-PC Trial aims to improve the effectiveness of delivering these vital services. 

Palliative care is often confused with end-of-life Hospice care, but they’re very different. While hospice care focuses on comfort specifically at the end of life, palliative care is specialized medical care designed for people living with a serious illness, regardless of their treatment plan or preferences. Interdisciplinary teams of providers offer care designed to alleviate the symptoms and stresses of serious illness, thereby improving the quality of life for patients and caregivers. 

Research has demonstrated the benefits of palliative care for patients, caregivers, and hospitals:

• Patients Benefit from improved symptom management, enhanced mental health, financial savings, and a longer life.

• Caregivers: Serious illness education, practical tools for caregiving, and support to relieve caregiver stress and burnout.

• Hospitals: Enhance the quality of care by reducing the length of intensive care unit and hospital stays, minimizing unnecessary tests, and lowering the number of times patients are readmitted to the hospital.

Palliative care teams support patients and caregivers with a wide range of services, including understanding hospital resources and treatment options, making treatment decisions that align with their goals and values, addressing depression and anxiety, managing physical symptoms and side effects of treatment, providing spiritual support, and connecting them to community resources. And that’s just the start. 

Related reading: Research Examines Earlier Equitable Access to Palliative Care Services.

Longstanding leadership in palliative care.

We know that palliative care is effective, and we understand that the sooner we can provide this additional layer of support for patients with serious illnesses, the better their outcomes can be. That makes palliative care one of the few ways we can help patients feel better while improving the bottom line for hospitals.

MedStar Health’s deep experience with palliative care and its large, diverse patient population makes it an ideal partner for the PAIR Center. We conduct research in partnership with patients and families, including an essential Study Advisory Council whose members help us design our research to answer questions that matter to the patient experience.

Working together, we can help more patients gain earlier access to palliative care, thereby improving the course of their illness and enhancing their quality of life through additional support. By removing barriers to access, we aim to help more people receive the care that can improve their well-being.