Promoting excellence in end-of-life care: a report on innovative models of palliative care.
ABSTRACT Promoting Excellence in End-of Life Care, a national program of The Robert Wood Johnson Foundation, funded 22 demonstration projects representing a wide range of health care settings and patient populations to develop innovative models for delivering palliative care that addressed documented deficiencies in the care of patients and families facing the final stage of life.
To determine the practicality (feasibility of development and operation as well as acceptance by stakeholders) of new models of care and to determine the impact of the models on access to, quality of and financing for palliative care.
The program cannot report scientifically rigorous outcomes, but the grant-funded projects used a variety of methods and measures to assess acceptance of new models and their impact from the perspectives of various stakeholders, including patients and their families, clinicians, administrators and payers. While it is not possible to aggregate data across projects, the data reported to the Promoting Excellence national program office were used to describe program impact with respect to the practicality of palliative care service integration into existing clinical care settings (feasibility and acceptance by stakeholders), the availability and use of palliative care services (access), quality of care (conformance to patient expectations and accepted clinical standards) and costs of care.
The 22 projects provided services in urban as well as rural settings, in integrated health systems, hospitals, outpatient clinics, cancer centers, nursing homes, renal dialysis clinics, inner city public health and safety net systems and prisons. Populations served included prison inmates, military veterans, renal dialysis patients, Native Americans, Native Alaskans, and African American patients, inner-city medically underserved patients, pediatric patients, and persons with serious mental illness patients.
Hosting or adopting institutions sustained or expanded twenty of the 22 models, and feedback from all stakeholders was positive. Project sites developed and utilized new palliative care services and addressed quality through implementation of new standards and clinical protocols. Costs of care, where they could be assessed, were unaffected or decreased for project patients versus historical or concurrent controls.
The 22 Promoting Excellence in End-of Life Care projects demonstrated that by individualizing patient and family assessment, effectively employing existing resources and aligning services with specific patient and family needs, it is possible to expand access to palliative services and improve quality of care in ways that are financially feasible and acceptable to patients, families, clinicians, administrators, and payers.
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ABSTRACT: Abstract Staff carers in pediatric skilled nursing facilities (PSNF) deal directly with dying residents, and are on the forefront of communication with families. These providers have expressed misunderstandings regarding the meaning of resuscitation status and redirection of care. This descriptive study evaluated perceptions and understanding of end of life issues by the staff in a PSNF who provide care for individuals with severe developmental disabilities and complex medical problems. A 16-item pre-intervention survey was administered to the staff prior to an informational presentation explaining issues related to end of life care. An 8-item post-intervention survey assessed any change in understanding of these issues. A total of 55 persons completed either a pre- or post-intervention survey; 47 staff completed both surveys. While most staff carers were comfortable with providing care for patients with serious illnesses or needing comfort measures (narcotics, oxygen) when they are dying, they are significantly less comfortable with discontinuation of feeds or routine medications at the end of life. Observed was a significant increase in those who indicated it is acceptable to stop feedings for a dying patient in the post-intervention survey, but there no significant difference in understanding of definition of DNR before or after the intervention. Authors note the need to provide more comprehensive information and support to assist staff carers to understand aspects of end of life care in a PSNF setting.Journal of Policy and Practice in Intellectual Disabilities 03/2008; 5(1):56-64. · 0.97 Impact Factor
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ABSTRACT: Palliative care has been one of the most rapidly growing fields of health care in the United States in the past decade. The benefits of palliative care have now been shown in multiple clinical trials, with increased patient and provider satisfaction, equal or better symptom control, more discernment of and honoring choices about place of death, fewer and less intensive hospital admissions in the last month of life, less anxiety and depression, less caregiver distress, and cost savings. The cost savings come from cost avoidance, or movement of a patient from a high cost setting to a lower cost setting. Barriers to expanded use include physician resistance, unrealistic expectations of patients and families, and lack of workforce. The future of palliative care includes more penetration into other fields such as nephrology, neurology, and surgery; further discernment of the most effective and cost-effective models; and establishment of more outpatient services.Annual Review of Public Health 03/2014; 35:459-475. · 3.27 Impact Factor
- Journal of Pain and Symptom Management 01/2011; 41(1):310-311. · 2.74 Impact Factor