Circles of Influence 2006

Organization: Continuum Hospice Care, New York, NY.  Innovations highlights were the hospice’s Open Access focus on clinical indicators rather than prognosis, reliance on evidence-based medicine, and elimination of cost considerations and complexity as factors in hospice eligibility.

Recent Developments:  The Open Access program was able to take complex cases, as it relied on the medical expertise of the Beth Israel program and a team of physicians who reviewed cases. However, the program was not financially sustainable, with the hospice spending $100,000 a month on Open Access for which it was not reimbursed.  

The hospice first moved to a complex case management that did evaluations and then ended even the modified Open Access in October 2009.  Ending the Open Access program was anticipated to reduce the hospice’s census by about a quarter—a $1.2 million loss.

The hospice is changing ownership.

What everyone learned was that you have to build protocols and make decisions on scope of service.

Organization:  Mercy Supportive Care, St. Joseph Mercy Oakland, Pontiac, MI.    The organization was cited for its hospital-wide culture that suffering in any form is not acceptable, palliative care services, stroke care model, and utilization person on the team to help with communication with insurance companies.

Recent Achievements:  The program is considered one of the hospital’s major service lines and continues to care for inpatients and outpatients.  It has added a third nurse practitioner and a massage therapist. The program has become involved with emergency department deaths.  In a program called Comfort Companion/No One Dies Alone, on-call volunteers respond to emergency room deaths and help with immediate, acute needs, and a hospice partner follows the family members, providing a year-long bereavement service.  The program is working with researchers to analyze and better understand the outcomes of this project.

The program has become a model within Trinity Health.

Award Impact:  The award carried a good deal of recognition locally (front page story of the Detroit Free Press, a staff/community celebration) and within Trinity Health, where the system president recognized the team at a major conference.  It has also had an effect on Trinity Health, which now has a system vice president for palliative care.  It cemented work underway in supporting other systems.   The Circle of Life Award and its representation of the importance of compassion in end-of-life care is part of the hospital’s employee orientation.     

After the award, organizations from across the nation called for information on the “no one dies alone” program.  Since 2006, the hospital has supported 205 clinicians/programs—and 57 long-term care facilities and hospitals have started a similar program with St. Joseph Mercy Oakland’s help.  Others were mentored on palliative care services, comfort carts, and other program aspects.

In 2008, the program was requested to present a conference session on the “trickle-down” effect of winning the Circle of Life Award. 

The organization sends part of its 2006 cycle application to others starting a program so they can see how the program has evolved and what quality indicators were used.  It captures the program’s story.

Award monies were used for a community recognition event, comfort carts, and program development.

Organization:  Transitions and Life Choices, Fairview Health Services, Minneapolis, MN.  Innovations recognized included an outpatient palliative care center, successful work with insurance on payment for palliative care, and use of different models of palliative care within the system.

Achievements since Circle of Life Recognition: Now called the Palliative Care Program, the program received The Joint Commission’s Advanced Certification in Palliative Care in 2013. The palliative care program is designated as a Palliative Care Leadership Center .™ Dedicated palliative specialists are available in five Fairview hospitals including the University of Minnesota Medical Center. A Pediatric Advanced and Complex Care Team (PACCT) serves children and families in the University of Minnesota Children’s Hospital, with pediatric palliative home care and hospice available. We have the largest network of outpatient palliative care clinics in Minnesota, with a focus on integration with University of Minnesota Cancer Care. A new palliative care clinic has been established in collaboration with the heart failure program.  A Palliative Medicine Fellowship with an adult and pediatric track, a palliative care clinical social work fellowship, and rotations for advanced practice nurses and medical residents demonstrate the teaching mission of the academic palliative care program. The program participates in the Honoring Choices MN and POLST programs to support advance care planning and ensuring patient goals of care are communicated. A Serious Illness Communication education program is offered to clinicians in oncology, cardiology and primary care.  Quality improvement projects focus on timeliness of palliative care consults for ICU patients, and palliative care for oncology patients receiving palliative chemotherapy. 

Award Impact: Within the health care system, the award was seen as external acknowledgement of program excellence.

Circle of Life award funds were used to create a Fairview Circle of Life award-to help Fairview employees implement innovative ideas with project funding.  Examples include palliative care education for pediatric bone marrow transplant nurses, development of a fellowship in palliative social work, perinatal palliative care, and offering ELNEC throughout the system.