Factors Impacting Serious Illness: A Mixed Methods Case Study of 4 Alabama Health Systems

Outcomes 1. The attendees will be able to describe factors that impact availability of hospital palliative care.2. The attendees will be able to describe environmental factors and hospital characteristics that are common and different across hospitals with and without palliative care. Key Message There are variations in hospital palliative care growth based on geographic location and hospital type. This mixed methods case study assessed palliative care in Alabama based on in-depth exploration of four different hospitals. Clinician champions, supportive administration, and mission fit are major factors influencing palliative care development across four hospitals. Introduction Hospital PC has expanded in the United States, though growth has varied in different geographic locations and hospital types. Given the Southern U.S.’s overall low ratings in palliative care access, the purpose of this study was to develop a thorough description of palliative care in Alabama hospitals. Methods This was a mixed methods multiple case study of four Alabama hospitals (2 with and 2 without hospital PC). Quantitative data included assessment of environmental factors and a descriptive hospital survey, and were analyzed using descriptive statistics. Qualitative data were collected through semi-structured interviews with staff and administrators and analysis of serious illness care documentation, and analyzed using a thematic, within-case and cross-case approaches. Results Hospitals with PC were large, in an urban setting, nonprofit, and served multiple rural counties, while hospitals without palliative care were for-profit and served a smaller catchment area, with a focus of care on surgical and maternal/child services. The factors reported for having hospital PC was clinician champions, supportive hospital administration, and mission fit despite limited funding. Serious illness care at hospitals without PC was focused on end-of-life care and goals of care conversations. All hospitals used critical care rounding; however, the disciplines and discussions included in the rounds differed. Serious illness and palliative care training was offered at hospitals with palliative care. Hospitals without palliative care offered few voluntary training opportunities related to serious illness care. Conclusion Environmental factors, such as location, and hospital characteristics, such as ownership, support previous literature on the existence of PC. Hospitals with palliative care utilized palliative care champions, multidisciplinary rounding, and focused palliative care training as core factors of the palliative care program and these should be considered in practice, warrant further research, and policy change to impact the care of patients living with serious illness. Keywords Models of Palliative Care Delivery