Session Summary: Community palliative care is underutilized despite its value within the care continuum. In this innovative model, nurse practitioners leverage technology and population health tools to conduct virtual palliative care visits to reduce preventable readmissions, improve symptom management, increase patient satisfaction and enhance caregiver resilience. Virtual visits are used to optimize patient outcomes through comprehensive medication management, proactive home safety evaluation and dynamic assessment of caregiver burden to identify risks. Initiated prior to a patient’s discharge from an inpatient or skilled nursing facility setting, this drives the agenda for future virtual and in-person visits, mitigates undesirable outcomes, optimizes patient autonomy and enhances continuity of care.
Learning Objectives:
At the completion of this session, learners will be able to:
Identify innovative strategies that leverage technology and population health goals to optimize patient outcomes in community palliative care.
Assess medication, safety and burden of care risks and deploy strategies to help mitigate undesirable outcomes and preventable hospital readmissions.
Improve community palliative care practice to enhance patient outcomes and satisfaction and advance population health goals.
