(P15) Advancing Dementia Care: Palliative Care Performance Improvement to Enhance Quality-of-Life

Objective/Aim: The Coler Rehabilitation & Nursing Care Center Memory Care Unit (MCU), comprised of over two-thirds racial and ethnic minorities, provides high quality palliative care to this population which studies show lacks access to specialized dementia care. This Performance Improvement (PI) aim was to increase enrollment of nursing home (NH) residents with recent functional and/or cognitive decline in our MCU Palliative Care Program by at least 30% from July 2023 to July 2024, and overall MCU enrollment to > 50% by the end of the 3rd quarter of 2024 to improve their quality-of-life. Our equity lens focus was to enroll a similar share of minorities in our MCU Palliative Care Program.

Background: According to a National lnstitute of Aging study, nursing homes (NHs) specializing in dementia care have improved outcomes, but few U.S. NHs offer such care. Our MCU recently received the American Association of Critical Care Nursing’s Beacon Award for Excellence, recognizing the high-quality dementia care it provides.

Coler utilizes key metrics in such areas as fall reduction, avoidance of tube-feeding in advanced dementia, reduction of antipsychotics, prevention of end-of-life hospital transfers and expansion of Palliative Care Program enrollment for those with recent decline. By increasing palliative care enrollment, improvements in outcomes in all these key metrics were achieved, via provision of person-centered, goal concordant care, tailored to the needs/preferences of this diverse populations.

Quality Improvement Methods: We utilized the PDSA (Plan, Do, Study, Act) methodology, based on our existing key metrics. Between 7/1/23 and 9/30/24, we tracked monthly enrollment of MCU residents in our palliative care program in pursuit of our aim, making necessary changes, based upon primary and secondary drivers, illustrated in our poster.

Results : From 7/1/23 to 7/31/24, palliative care MCU enrollment increased by 33%, exceeding the 30% goal, and by 9/30/24, total enrollment was 58%, surpassing the 50% target. By 9/30/24, 78% of enrollees were minorities, consistent with our equity lens focus, as were 88% of new enrollees in calendar year 2024. Of the 14 resident mortalities in palliative care during this 15-month time span, 100% died in our MCU, and all had Do not resuscitate/Do not intubate orders at time of death, sparing them from non-beneficial treatments at the end-of-life, consistent with our palliative care approach.

Conclusions: This PI initiative was highly successful. Our dementia care model could be expanded to other NHs in our health system and elsewhere. Specialized dementia care models like ours are consistent with both the PALTmed and our health systems mission to overcome access inequities to high quality post-acute care for minorities. Our care model embodies key PALT-med values, such as person-centered, goal concordant care, while promoting diversity, equity and inclusion. In view of our promising result, further research in this vital area is warranted.