Background: Advance Care Planning (ACP), palliative care (PC), and enrolling inpatients near end of life into hospice are known methods to improve patient experience and reduce inappropriate use of inpatient (IP) resources. We sought to increase ACP, PC, and hospice referral by proactively identifying patients near end of life. Methods: In 2020 we introduced the [...]

Background: Background: Essentia Health St Mary’s Medical Center, a tertiary referral center serving the rural areas of Northeastern Minnesota and Northwestern Wisconsin, identified disparities in hospice utilization of Medical Shared Savings Programs (MSSP) decedents in 2021 – 2022 (40% vs 53% Medicare national, 2nd quarter 2022). Health system metrics on hospital readmission and length of [...]

Case Presentation: A 70 year old female with metastatic cholangiocarcinoma, heart failure with reduced ejection fraction, stage 4 chronic kidney disease and pulmonary embolism on anticoagulation presented to a NYC safety net hospital with bilateral lower extremity edema, dyspnea at rest and a recent unwitnessed fall. Her malignancy was diagnosed 7 months prior and her [...]