Circles of Influence 2004

Organization: Hope Healthcare, Fort Myers, FL. The new name better emphasizes its enhanced circle of care and new long-term care services. Innovation highlights associated with the award included palliative care open access, outreach to long-term care and effective physician relations strategies.

Achievements since Circle of Life Recognition: Since receiving the Circle of Life Award, Hope has made great strides in moving palliative care services farther upstream to benefit even more people in the community, particularly the rapidly growing number of aging baby boomers - long-term care in addition to hospice and bereavement care.

The organization now cares for more than 2,000 people each day and their families through person-centered programs and bereavement services. In addition to hospice services, Hope now offers:

Hope PACE: A Medicare/Medicaid Program of All-Inclusive Care for the Elderly that provides a total health care solution for people 55 and older, enabling them to maintain independent living

Hope Connections: A Florida Department of Elder Affairs Community Care for the Elderly (CCE) program, offering home-based independent living for people 60 and older

Hope Palliative Care: Care plan development and navigation, emotional support and symptom management for everyone living with serious illness

Hope Parkinson Program: Services and activities for people living with Parkinson's Disease and their care partners, to help them experience fullness of life

Hope Kids Care: Pediatric hospice care, care for long-term, life-limiting illness and help for children coping with grief

Hope Visiting Nurses: Home health care, private duty nursing and home health aide services

Hope VALOR Program: Specialized care for veterans including spiritual and emotional support and recognition for service

Hope Healing Hearts: Counseling and support for those who have experienced the loss of a loved one

Hope at Work: Professional support services provided to businesses at no cost; help with grief, illness and caregiving

Hope Pet Program: Care and support for the pets of hospice patients

By design, Hope's programs of care can be replicated by other health care organizations to meet the needs of the community — offering specialized care and comfort. After receiving the Circle of Life Award, Hope has been visited by healthcare professionals from around the country, to learn more about creating additional palliative care programs.

Award Impact: The 2004 Circle of Life Award garnered positive community reaction and increased awareness of the value of Hope's innovative programs. It reinforced Hope's respected brand and helped to strengthen relations with hospitals, nursing homes, assisted living facilities, other health care organizations and the community at large. Hope continues to build on that foundation in developing collaborative programs.

The Circle of Life award application process required thoughtful introspection and self-evaluation, enabling Hope to better articulate its work and goals.

Organization:  St. Mary’s Healthcare System for Children, Bayside, NY.  The organization was cited for it palliative care pathways, early intervention program for infants, and development of peaceful dying plans with families.

Recent Achievements:  The organization continues to spread services throughout and it has been successful in bringing its staffing model into its regular interdisciplinary teams—educating existing social work and nursing staff in palliative care.  It still uses an integrated bed model.  A palliative care consultant, who helps with pain and symptom management for children receiving palliative care, also trains staff who work with other children.  Staff has been trained to incorporate complementary and alternative medicine for all patients—yoga, aromatherapy, and reiki, for example.  A new trained-volunteer doula program provides the child and parent support at the end of life.  The organization has also increased program evaluation rigor.

The facility is working toward palliative care for all children.

The organization has, over the past few years, focused on disseminating its three-tiered care model, presenting papers at palliative care conferences and an international hospice conference.

Award Impact:  The Circle of Life Award gave such pride within the organization and improved its ability to promote its program and to maintain philanthropic funding.  The external recognition reinforced its own sense of achievement and pride and increased staff motivation.  The Circle of Life is a sign of national recognition and excellence…a seal of approval.  It gave internal confidence and is wonderful to communicate to funding organizations.

Organization:  University of Texas M.D. Anderson Cancer Center Symptom Control and Palliative Care Program, Houston, TX.  This cancer center’s program of a palliative care consult team and an inpatient unit continue to incorporate palliative care earlier in the disease process and alongside curative care. Innovative highlights included bus rounds with local hospices, no waiting room in the outpatient palliative care center and strong research and publications.

Achievements since Circle of Life Recognition: The award continues to impact our department and center. Our department now includes the sections of palliative care, rehabilitation medicine and integrative medicine. Our department, now has 42 faculty, including 5 psychologists and a basic science researcher. Any patient can be seen on the same day as referral. We operate 3 clinics in the morning and afternoon, 5 days a week that are never cancelled. We now have 6 mobile teams for our inpatient consult service, including one specifically for pediatric inpatient consults which is allowing us to expand our pediatric palliative care program. As we have continued to grow, we experienced a saturation of clinic space, and we moved into a newly renovated space where our Supportive Care Center now runs 3 specialty clinics: the supportive care clinic, the physical medicine and rehabilitation clinic, and the cachexia clinic. We also have a psychosocial team, including 3 psychologists and 4 counseling associates.

We have grown tremendously since 2004, from serving 1,397 unique patients to serving 4,888 patients that resulted in 13,016 outpatient visits. Our mobile team inpatient consult service saw 4,089 unique patients this past year, which resulted in 5,807 visits. Our acute palliative care inpatient unit (APCU) saw 821 unique patients this year (admits and discharges). Since the name change of our outpatient center to Supportive Care, referrals have increased 41 percent in a study we conducted that reviewed 4,701 referrals until the change in name and beginning 6 months after the name change. Our acute palliative care inpatient unit has showed in a recent study that approximately 70 percent of our patients admitted to the unit are discharged alive. Lastly, the cost of care of patients referred to Supportive Care is lower than patients not referred to the program.

We have increased our research funding as well, having received 6 R01 awards, 3 R21 awards, 2 K awards, 7 ACS awards, and multiple institutional research grants and sponsored research agreements. We recently also signed a strategic alliance with Helsinn Therapeutics to develop and run clinical trials using their therapeutic agents. We continue to have several educational community bus rounds each year, and our annual conference attendance has grown each year since receiving the award. In addition, our research publications in peer-reviewed journals has more than doubled, from approximately 400 to over 950 unique publications.

As previously mentioned, the Integrative Medicine program is also now a part of our department, as is their outpatient center, which offers physician consultation, acupuncture services, exercise and physical activity consultation, health psychology, meditation, music therapy, nutrition consultation, and oncology massage. They have also grown with the addition of 2 new faculty psychologists.

Award Impact: The cancer center’s staff had increased confidence in referring patients to the Symptom Control and Palliative Care Program — the award validated the program’s quality to University of Texas M.D. Anderson Cancer Center colleagues and heightened internal awareness, leading to greater confidence in making referrals. Externally, many cancer center visitors know about the Circle of Life Award and request to observe the palliative care program. Our program welcomes over 100 observers and visitors annually, from around the world (national and international).

Award funds were spent primarily on education for staff and for families about the palliative care service and our center.

The application process forced the program to define itself and to establish monitoring/evaluation measures. It identified areas where the program needed to focus to keep up with other leading programs. We continue to further develop our clinical and research programs in order to meet the needs of our patients and their families.