With better communication about advanced illness care options and end-of-life planning, physicians have the potential to make significant improvements in healthcare access, utilization, cost and outcomes, says Brentwood, Tennessee-based Kurt Merkelz, MD, senior vice president and chief medical officer of Compassus, a national provider of hospice, palliative and home healthcare services. He notes that to improve communication, there needs to be a better understanding of the goals and preferences of an individual patient, and these discussions can only meaningfully occur by way of shared decision making.
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“An informed discussion occurs when information is fully disclosed, a patient’s values, beliefs, and preferences are top of mind and a recommendation is made based on an accurate estimation of a patient’s prognosis,” Merkelz says. “However, a lack of quality prognostic markers is a potential barrier to fruitful shared decision making.”
Thanks to advances in analytics, a productive way to address this gap is to use electronic medical record data extraction and improved predictive analytics to estimate probability outcomes. According to Merkelz, past algorithms have utilized non-clinical data and manually extracted data for calculations, limiting their usefulness. Enhanced data analytics, on the other hand, offer the opportunity to better identify patients who are at risk for hospitalization and offer other insights into a patient’s care needs.
“This allows patients to better plan for the type of care they would like to receive throughout their health care continuum,” he says. “Having these important goals of care conversations with patients helps them access beneficial services like home health, skilled therapy, and hospice and reduce unwanted hospitalizations, procedures and treatments, creating a better quality of life for them and their families.”
A sobering fact is that 75% of patients are unable to make some or all decisions at end of life, according to Amy Berman, RN, a senior program officer with the John A. Hartford Foundation.
“Data analytics offer the possibility of better supporting advance care planning and goal-concordant care by identifying populations at greater mortality risk at a point when advance care planning can be initiated or decisions can be reviewed,” Berman says.
In addition to helping address the concerns of individual patients, these tools offer potential for positive change on a large-scale basis.
“We can use data analytics to root out disparities around access to palliative care, advance care planning, and the provision of unwanted care,” Berman says. “Data analytics offer the possibility of addressing what matters as our nation ages."
At the same time, another reality is that the potential for such analysis is often misunderstood, says Greg Horne, principal health analytics strategist at software and analytics provider SAS.
“This is one of those mine fields where people are afraid that computers will one day decide whether you get to live or die,” he says. “That’s a gross mischaracterization, of course, but a real fear for many.” He says that those who express such worries are putting the emphasis in the wrong place. The real potential is not about the data or analytics but how data and analytics can inform the real human decisions that happen around end of life.
“Doctors, patients, and families are often forced to make end-of-life decisions based on limited knowledge, guided more by gut reactions than actual evidence,” Horne says. He suggests instead imagining an artificial intelligence-based decision support system that helps these key stakeholders understand potential options and the likely outcomes associated with each.
Horne notes that given all the complexities involved, the primary opportunity is in the centralization and aggregation of all relevant data. Then insights extracted from that data available can be provided to key decision makers via customizable reports and dashboards.