Circles of Influence 2003

Organization:   Hospice & Palliative CareCenter, Winston-Salem, NC.  Innovation highlights noted were the Community Partnership for End of Life Care (nearly 250 community organizations and individuals), medical school curriculum in hospice and palliative care, and a comprehensive, creative blend of services.

Recent Achievements: Since receiving the award, our geographic growth has been, in part, by invitation from other providers who recognized our expertise and ask for us to assume the role of primary hospice provider. To that end, we opened three free-standing offices between 2003 and 2006. Today we serve 13 counties, with a 40-bed hospice home on our main campus in Winston-Salem and a 14-bed hospice home in Salisbury/Rowan County. In addition to our ongoing palliative care program whereby we serve patients in their home or extended care facility, we built an on-site palliative care clinic in 2010 when we were expanding our hospice home and building additional office/meeting space.

Our efforts that were recognized when we received the award continue in earnest. Our regional Community Partnership for Compassionate Care group created an innovate tool known across the region and most parts of the state as “Got Plans?” (and www.gotplans123.org). This initiative was embraced by all members of the partnership and a labor of love, even among two competing major medical centers who share a passion for Advance Care Planning. In this same vein, we are now the ‘home’ of the state-wide coalition known as the North Carolina Partnership for Compassionate Care.

In 2015, Hospice & Palliative CareCenter was recognized as a national leader in quality in a comparison of 1,700 hospice providers. Specifically, in a Deyta survey of caregivers being asked about their experience of care, Hospice & Palliative CareCenter was ranked as one of the top 30 in the country, being awarded Elite Status. Since then, we have received additional awards and honors when judged by caregivers evaluating their experience of care.

Award Impact: The Circle of Life Award spotlighted to the community the value of working together proactively on quality of life issues. This message was particularly furthered for the town’s two medical centers, which both support the hospice and the partnership. It was an important model because it spotlighted a hospice as convener, pulling everybody together.

When applying to foundations for grant money, the Circle of Life Award is viewed as a “real plus.”

Other programs applying for the Circle of Life Award have asked us for advice—and we stress innovation. The application process forced collaboration and contributed to an overall sense of cohesiveness. It also serves as a constant reminder of the true value of collaboration and keeping a focus on the greater good, especially as we recognize the value in integrating our work with hospitals and other health care and end-of-life care providers.

Organization:  Providence Health System, Portland, OR.  Providence was the largest system in Oregon, with a Portland service area with two tertiary-care hospitals, a community hospital, hospice, employed and affiliated physician groups, an HMO, and a PACE site. It provided an average 8,000 end-of-life interventions yearly. The end-of-life care program was integrated throughout the large system.

Innovation highlights cited were system-wide commitment to end-of-life services, a “family of measures” index for quality improvement, and an emphasis on advance care planning.

Recent Accomplishments: Since establishing a Regional Palliative Care Program for the state of Oregon in 2010, in 2017 we have dedicated Palliative Care staff providing consultation on Goals of Care and Symptom Management at five of the eight hospitals operated by Providence Health & Services in Oregon. Additionally, our outpatient program sees patients in three specialty clinics as well as visits in patient homes, and SNF’s. This team also supports our Home Health Palliative Care Teams. Given the need for palliative care services is larger than the resources we have to serve from our program, our program is placing effort in educating primary care and specialty providers to be generalist in palliative care. In 2016 these efforts reached 2900 individual caregivers in our system.

In 2015, in response to the shortage of palliative care providers, we were able to develop a Nurse Practitioner training program with three levels of competency. Level one is appropriate for primary care and specialty clinics. This level involves approximately six hours of training. Level two is geared toward development of a mid-level Palliative Care Nurse Practitioner. This level of training is also appropriate for NP’s embedded in clinics. It involves a total of ten days of training. The curriculum was piloted in early this year in collaboration with the Cancer Program Palliative Care NP. The third level of training prepares an NP to sit for their exams. This will be a year-long training effort. Our goal is to embed these NPs in our outpatient primary care and specialty clinics who can then model for MD’s approaches to goals of care conversations. Along with this effort we provide education to our medical staff and front line caregivers through lectures and formal presentations. This effort reaches approximately 800 providers and caregivers per year.

Award Impact: The Circle of Life Award gave the program the momentum to start the palliative care teams. In addition, the award got the program noticed, giving the grassroots program importance and credibility with the system administration. It also opened relations with other organizations, including Oregon Health Sciences University Hospital, and joint conferences with hospitals.

With the award monies, the program produced a pocket-sized laminated card for physicians and nurses on symptom management, pain control, and family meetings. In addition, a family booklet was created and is being translated. Some funds supported physician attendance at a national palliative care conference.

Organization:  University of California Davis Health System, Sacramento, CA.   Innovations included an academic medical center with a palliative care culture, a palliative care curriculum throughout medical education, and outreach to underserved populations.

Recent Achievements:  Since receiving the AHA Circle of Life Award in 2003, UC Davis has transformed into UC Davis Health System with interprofessional schools of health, including UC Davis School of Medicine, the Betty Irene Moore School of Nursing, and graduate programs in Informatics and Public Health.  Together, they make UC Davis a hub of innovation that is "improving lives and transforming care."  For more information, visit healthsystem.ucdavis.edu.

Frederick J. Meyers, MD, received an NIH National Cancer Center R25 to explore simultaneous care in a multi-institutional randomized study, "Improving care in the end of life: Developing an instrument to assess the process and content of end-of-life discussions between physicians and their dying patients, using unannounced standardized patients in primary care resident clinics."

Palliative care has been woven into all aspects of the medical education curriculum at UC Davis School of Medicine.  By May 2012, simultaneous care, or concurrent care, has emerged as the new standard to aim for in cancer care. A broad-based expansion of pediatric palliative care is underway.

Award Impact:  The Circle of Life Award brought a broader awareness to the importance of palliative care within UC Davis Health System, the Northern California region, and the University of California system.  The award also brought local, regional, and national attention.  The award was also credited with helping achieve organizational funding for an inpatient consultation service, initially funded by the California HealthCare Foundation and now self-sustaining.

Dr. Meyers traces more-recent awards and foundation funding to the program's achievements brought to light by the Circle of Life Award.  The leader also credits the State of California Legislature's Resolution #1541 for Palliative Care Education & Research to the Circle of Life Award.

The impact goes far beyond personal achievements and national leadership in palliative care.  UC Davis Health System's palliative care culture and quality of care daily improves.  With these efforts, the entire organization received national recognition for the collective work in palliative care and in educating future physicians to provide this care for many more generations to follow.