Date: 09/01/2009
Final
Center for Improving Value in Health Care
HOSPICE AND PALLIATIVE CARE
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01:11 PM -- Center for Improving Value in Health Care
Dr. Jean Kutner, from the University of Colorado Denver School of Medicine, representing the Center for Improving Value in Health Care (CIVHC), began her presentation and provided a handout to the committee (Attachment K). She provided background on CIVHC and its goals which include bringing consumers, business, providers, insurance companies, and state agencies together to develop recommendations for improving outcomes and increasing value in the health care system. Dr. Kutner described CIVHC's Palliative Care Task Force and its members. She then described the vision of the Palliative Care Task Force for end-of-life care. Dr. Kutner described a model of transitions from curative to palliative and hospice care.
Senator Williams referenced prior data on the length of stay in hospice in Colorado, and asked Dr. Kutner's opinion on this and if she had any recommendations. Dr. Kutner said that she believed that hospice care could be used earlier in the process when the debilitating symptoms of terminal diseases begin. She highlighted the need for public education. Representative Tyler asked if patients are surprised about the options for palliative care. Dr. Kutner said many patients view curative care and hospice care as an "either/or" situation, which is partially the result of how care is funded. Representative Roberts asked if it is true that if a patient receives palliative care that it can be life extending, whereas hospice does not have that goal. Dr. Kutner said there is mixed evidence on the issue, but some evidence shows that people live longer in palliative and hospice care, likely because they are more comfortable.
01:27 PM
Dr. Kutner described the priorities of the Palliative Care Task Force and steps that can be taken to achieve these goals. She then described potential approaches for increasing palliative care in Colorado which include using data, conducting demonstration projects, reforming payment methods for palliative care, and defining standards for palliative care.
01:36 PM
Dr. Kutner described some sample metrics for evaluating the success of increasing palliative care and improving quality. She laid out the task force's strategy and schedule for making recommendations and developing an action plan. Representative Roberts asked about culture change for doctors in order to increase palliative care. Dr. Kutner said that it is increasingly a focus among medical students and that having the palliative care center at the University of Colorado Medical School increases exposure. She then elaborated on the difficulty of changing physician behavior. She discussed continuing education requirements in other states.