Symptom Burden and Palliative Care among Patients with Multi-Morbidity

Patients with multi-morbidity are extremely common, but may not be identified as being at high risk of death and hence may not receive palliative care. The project will determine symptom burden and quality of life among patients with multi-morbidity at high risk for 1 year hospitalization or death and to compare health care utilization among such patients at the end-of-life with and without cancer. Goals include conducting research among patients in the top 10% risk for 1 year hospitalization or mortality due to their multiple comorbid illnesses: 1) to assess symptom burden, health-related quality of life, and patients’ perceptions of symptom assessment and management; and 2) compare health care utilization at the end-of-life among patients who died with cancers and without cancers. In 2012, the Department of Veterans Affairs (VA) rolled out to primary care clinicians a prognostic model called the Clinical Assessment Needs (CAN) score that was developed and validated using information from the nearly 5 million Veterans receiving primary care. Utilizing the CAN score to identify high risk patients may ultimately improve the health status of patients by identifying their needs, gaps in practice, and emphasizing the need to implement palliative care into primary care settings. The knowledge generated from this research has the potential to inform operational partners how to better appropriate resources to deliver quality palliative care and assist policy makers in developing novel ways to identify target populations who may benefit from palliative care services.