Alternative Payment for Palliative Care: Getting from Here to There (SA503)

Abstract

Describe the needs of DT-LVAD patients beyond their medical therapy and identify measures that support the multidisciplinary LVAD team. Destination therapy left ventricular assist devices (DT-LVAD) offer life in the setting of ultimate death with the device in situda trajectory that can be complicated for patients, caregivers, and providers. Advancements in LVAD technology and the growing concept of a truly multidisciplinary team have set the stage for a comprehensive program of support. However, with this life-sustaining therapy challenges persist in our endeavors to improve clinical and non-clinical outcomes. Significant challenges may arise for DT-LVAD patients, caregivers, and teams as patients transition from chronic LVAD support to comfort oriented care, in which a device may be properly functioning but the body weakening or a device decompensating in an otherwise stable patient. Although caregivers endure substantial burdens throughout the LVAD support trajectory, the level of caregiver burnout fluctuates and requires monitoring. Our focus in caring for this population must be twofolddon extending quality of life with this distinctive technology while simultaneously acknowledging the processes that will ultimately lead to end-of-life. Early and ongoing engagement of palliative care teams and DT-LVAD specific advance care planning (ACP) has the potential to augment patient-centered care and hone quality of life based interventions for patients and families. In this concurrent session, clinicians from a multidisciplinary team will define a novel approach to understanding the DT-LVAD advanced illness trajectory, reveal engaging strategies to break through barriers of complex ACP, uncover how bi-directional communication and education can enhance multidisciplinary team function, highlight the needs of DT-LVAD patients and caregivers beyond medical therapies, and discuss expanding options for approaching end-of-life care. Data from quality improvement work will provide an understanding of patient and caregiver quality of life approaching endof-life, clinician reported challenges, and system improvements in ACP processes. This session will offer clear strategies for redefining institutional best practices in collaborative and comprehensive DT-LVAD care.