Circles of Influence 2002

Organization:  Children’s Program of San Diego Hospice and Children’s Hospital and Health Center (now called Rady Children’s Hospital and Health Center),  San Diego, CA.   The collaboration between the hospice and the children’s hospital included traditional hospice care, perinatal supportive care, and palliative care management.
The program was cited for its innovations in a compassionate extubation program, early intervention program for parents with prenatal diagnosis threatening to unborn baby, and use of pediatric hospice standard orders and program-specific guidelines.

Recent Achievements:  The Children’s Program of San Diego Hospice partners with all the major health systems throughout San Diego and North County.  It now has a family practice/pediatric physician on staff and supports two geographically-divided children’s care teams.  In addition, the Children’s Program now offers pediatric palliative care consultation services at Rady Children’s Hospital, where relations are especially strong with hematology-oncology, pulmonary, and neonatal intensive care unit.

The perinatal hospice program now includes two other San Diego facilities—University of California San Diego Medical Center and Sharp Mary Birch Hospital for Women.

The hospice’s newest program, Partners for Children—a pediatric palliative care waiver program through the California Medicaid program— allows eligible children and their families to receive palliative care services during in the course of the child’s illness, while concurrently pursuing curative treatment for the child’s life limiting or life threatening medical condition.

The Palliative Medicine Fellowship Program at The Institute for Palliative Medicine at San Diego Hospice accepts physicians and nurses from all over the country and internationally.  It has trained one family practice physician specializing in pediatrics, one pediatric oncologist, and three medical-pediatric physicians and is adding a neo-natal intensive care physician next year.  The program has also mentored UCSD/Balboa Naval Medical Center residents; Rady Children’s nurses, social workers, nurse practitioners, and pain team specialists; and a child life specialist.

Award Impact:  Pediatric palliative care is financially difficult, with the small volume of patients and costly palliative care interventions, and care is increasingly not reimbursed.  Award dollars helped ensure continued existence and expanded services.

In additional, funds were used to train internal staff and external partners, as well as finance attendance at palliative care conferences.

The application gave the Children’s Program the opportunity to evaluate strengths and weaknesses of the program to best prepare for how to expand, improve, and continue services.

Organization:  Hospice of the Bluegrass, Lexington, KY.    The hospice was cited for its innovative bereavement groups for suicide and homicide deaths, specialized pediatric program available to rural families, and outpatient palliative clinic service.

Achievements since Circle of Life Recognition:  Hospice of the Bluegrass (HOB) continues to lead in the areas cited in the award as well developing new programs. The Palliative Care Center of the Bluegrass (PCCB) (a wholly-owned subsidiary of the hospice) currently manages palliative care programs at three Lexington hospitals.  St. Joseph Healthcare also houses a hospice in-patient unit. The University of Kentucky Medical Center (UKMC) has added a seven day a week hospice inpatient team to the palliative care services.  HOB piloted a joint hospice/palliative care team at UK‘s Children’s Hospital.  HOB partners with the UK Medical School to sponsor the Hospice /Palliative Care Fellowship. HOB/PCCB physicians have been granted attending status for hospice patients in both UKMC and Baptist Healthcare Lexington.  HOB has worked with the state cabinet for health services to implement the Concurrent Care Medicaid expansion for children permitted by health care reform.  In 2013, HOB became the only hospice and one of 102 nationwide to receive CMS Innovations Community based Care Transitions Program funding— for Kentucky Appalachian Transitions, a project designed to reduce avoidable hospital readmissions in high readmissions hospitals in Eastern Kentucky.  HOB contracts with private insurers to provide transitions services to other payers, particularly Medicare Advantage programs in Central and Northern Kentucky.

The Palliative Care Center of the Bluegrass is one of eight Palliative Care Leadership Centers, which provide intensive, operational training and yearlong mentoring for palliative care programs at every stage of development and growth. 

Award Impact:  The hospice credits the Circle of Life Award for its selection as a Palliative Care Leadership Center,   originally one of six (now eight) centers, which provide intensive, operational training and yearlong mentoring for palliative care programs at every stage of development and growth.  The centers were established by the Center to Advance Palliative Care and the Robert Wood Johnson Foundation in 2004.  The award added to the hospice’s reputation as a leader in the field.  The award process helped the hospice think through its “stars” and “signatures” in featuring achievements throughout the years. 

Organization: Project Safe Conduct of the Hospice of the Western Reserve and Seidman Cancer Center (formerly, Ireland Cancer Center), Cleveland, OH.  The project was cited for its innovations in integrating a palliative care in a cancer center environment, moving palliative care upstream, and collaboration between a hospice and an academic medical center.

Recent Accomplishments:   The provision of integrated palliative care within the acute care of cancer patients has continued. The Cancer Center formally assumed financial responsibility for the Cancer Support Team members after completion of the grant and extended the services provided by hiring a palliative care physician and making the services available to patients with all types of cancer.

Award Impact:  Within the cancer center it was “quite something” to be part of the Circle of Life Award; the award was displayed in the cancer center’s showcase. 

The team has had a major impact at Seidman Cancer Center.  But it has also had an impact on other organizations.  The then-director notes, as an impact of the Circle of Life Award, that there are to this day requests for a pain tool created by Project Safe Conduct and the model is highlighted in the Textbook of Palliative Nursing’s second edition and in the End-of-Life Nursing Education Consortium (ELNEC) curriculum.

Special Award Winner

Organization:  Population-based Palliative Care Research Network (PoPCRN), University of Colorado School of Medicine, Aurora, CO.   A research collaborative to expand the palliative care knowledge base, its innovation highlights were research conducted where care is given, collaboration with academic researchers, and focus on practical and policy issues.

Status:  PoPRCN ceased operation as a separate research network in mid-2014, folding its survey distribution component into NHPCO and its clinical trials into the Palliative Care Research Cooperative Group (PCRC) (http://palliativecareresearch.org/). PCRC develops scientifically-based methods that lead to meaningful evidence for improving quality of life of patients with advanced and/or potentially life-limiting illnesses and their caregivers, including family members and providers of care.

Award Impact:  The Circle of Life Award increased the research network’s visibility, particularly within the University of Colorado Health Sciences Center.  It carried validation that they were undertaking valuable work.  The application and site visit made them examine who they were, what they did, and why they did it.

PoPCRN helped hospices that are part of its projects apply for the Circle of Life Award, contributing insight on what mase these hospices innovative.

Award funds were used to host a convocation for participating hospices in conjunction with an NHPCO joint clinical conference in Denver, the network’s first full face-to-face meeting.