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Palliative Care Leadership Centers expand into community setting
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The Center to Advance Palliative Care announced the launch of three new Palliative Care Leadership Centers that will focus on home- and office-based care.
The effort is designed to expand palliative care beyond the hospital setting and into the community.
“To truly meet the needs of our society’s most complex and vulnerable patients, palliative care must be delivered where people facing serious illness actually live. We must expand beyond the hospital setting to reach people living at home, in nursing homes and receiving care in their clinician’s offices,” Diane E. Meier, MD, FACP, director of the Center to Advance Palliative Care and a HemOnc Today Editorial Board member, said in a press release. “Practical how-to knowledge, intensive coaching and mentoring from experienced leaders, and support for successful program-building through the Palliative Care Leadership Centers initiative, results in deep organizational capacity to serve this high-need population.”
The three new centers are Northwell Health in New Hyde Park, New York; Presbyterian Healthcare Services in Albuquerque, New Mexico; and University of Virginia Health System in Charlottesville, Virginia.
HemOnc Today spoke with Meier about how these leadership centers will work, as well as the impact she hopes they will have on patient care and outcomes.
Question: How did the idea for these leadership centers come about?
Answer: The idea came about through our sole funder at the time, the Robert Wood Johnson Foundation. They had very generously been funding the Center to Advance Palliative Care and talked to me about spreading the notion of centers of excellence throughout the country to serve as training hubs for a diverse range of hospitals and clinical programs. They suggested that we try to range from large academic medical centers to community hospitals, Catholic health systems, and hospices that are delivering nonhospice palliative care, so that is exactly what we did. We put out a call for proposals, received a significant number of responses, and went through a rigorous application and site visit process. We originally selected eight or nine facilities in 2004 to serve as leadership centers. At that point, we were solely focused on developing hospital palliative care. Since 2004, approximately 1,200 hospital palliative care programs have been trained. This is the equivalent to about 70% of all palliative care programs in the United States. We evaluated the ‘learners’ who went to these centers at 6 months, 1 year and 2 years after training. Of this group, 80% established sustainable palliative care programs.
Q: How did the three new centers come about?
A: We did another call for proposals last year to seek centers of excellence in delivering palliative care outside of the hospital — either in patient’s homes, office practices or nursing homes. We did this because there is a huge unmet need for people who are not dying, are not eligible for hospice and are not in the hospital but still have needs for palliative care. We decided to try to scale up the model of the Palliative Care Leadership Centers so it also applied to health care settings in the community. In 2016, we selected several new Palliative Care Leadership Centers based on their experience and excellence in delivering community-based palliative care. We then developed a new standardized curriculum that will be used by both veteran leadership centers and these new centers.
Q: How will they work?
A: Someone who is interested in receiving training will go to our website and identify the leadership center that best matches their own organization. They will apply and wait for a call back from the center where they applied. There then will be a telephone and online needs assessment to determine the fit of the learner’s institution and leadership center. There also will be some preparatory work done by the learning group at home. This includes a needs assessment, which involves informational interviews with key stakeholders to understand what the people with the power think is most important and concerning — in other words, what keeps them awake at night. There are short online training courses that the team must take before the face-to-face visit. Once onsite at the leadership center, users will receive intensive coaching for 2 days on how best to move forward. It is customized face-to face mentoring and coaching, and I think that is why this intervention is so successful. Then, ‘distance mentoring’ by the faculty continues for the duration of 1 year. This includes phone calls and regular email communication.
Q: What impact do you think the centers will have on patient care and outcomes?
A: Based on the impact of the hospital Palliative Care Leadership Centers, I expect we will see a rapid scaling up of access to palliative care in the community setting across the United States. We will see it in the home setting, office setting and eventually in nursing homes. It is now the standard of practice to have palliative care programs in hospitals, thanks to these leadership centers. We now want to make it equally standard to have access to palliative care no matter where you are.
Q: Could an initiative like this help address the concern that many hospitals and cancer centers do not have adequately staffed palliative care programs?
A: Ideally, it will help prevent unnecessary and preventable ED and hospital stays. For example, if a patient with cancer being seen at a cancer center has access to high-quality palliative care at the same time they have access to their oncology team, the likelihood that they will end up in the ED in a pain crisis and then hospitalized to manage that pain crisis should decrease significantly. It should reduce the burden on hospital palliative care teams. This being said, there will need to be an investment in staffing and capacity for all of these programs by hospitals, health systems, health insurers and office practices, because if staff capacity is not matched to the need for clinical services, it does not matter that there is a program in place.
Q: Is there anything else that you would like to mention?
A: The secret ingredient to the success of these leadership centers is the personal relationships that develop between the visiting team, the learners and the Palliative Care Leadership Center faculty. This is not something that I anticipated before we started this. No matter how good your content is, it is hard to overcome the challenges and barriers to establishing a sustainable, high-quality new program. It is the human connection, the human relationship, encouragement and support that I believe is the reason that these leadership centers have been so successful. – by Jennifer Southall
For more information:
Diane E. Meier, MD, can be reached at Center to Advance Palliative Care, 55 W. 125th St., Suite 1302, New York, NY 10027; email: diane.meier@mssm.edu
Disclosure: Meier reports no relevant financial disclosures.