Abstracts from theCenter to Advance Palliative Care National Seminar Pathways to Quality Palliative CareNovember 13–15, 2014Orlando, Florida

Abstract

Journal of Palliative MedicineVol. 18, No. 4 AbstractsFree AccessAbstracts from theCenter to Advance Palliative Care National Seminar Pathways to Quality Palliative CareNovember 13–15, 2014Orlando, FloridaPublished Online:20 Mar 2015https://doi.org/10.1089/jpm.2015.1021.abstractsAboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail The topic areas for abstract submission include: • Innovative and emerging community-based palliative care models (e.g., home/office/clinic/long-term care)• Innovative and emerging hospital-based palliative care models• Integration of palliative care services in cancer centers/dialysis centers and other special care units• Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty) or in specific settings (ICU, ED)• Pediatric palliative care program development including combined adult/pediatric models• Staffing the interdisciplinary team including staffing benchmarks and maximizing the roles of social workers/chaplains/nursing and medicine; how teams work together to maximize team health and avoid burnout; and demonstrating clinical and financial outcomes for team roles• Communication best practices (e.g., teaching goals of care conversations/advance care planning and implementation of POLST/MOLST)• Integrating palliative care services (e.g., across a health-system/patient-centered medical home/assisted living/nursing homes)• Using technology to improve efficiency and outcomes• Methods of training in primary/generalist palliative care (e.g., palliative care training for hospitalists and unit nurses in communication and symptom management)• Implementation of standardized interventions such as checklists and screening tools• Financing/benefit and payment models• Regional and national palliative care initiatives (e.g., statewide coalitions/political advocacy)• Identifying appropriate outcomes and working with key stakeholders and partners• Preparing for The Joint Commission Advanced Certification for Palliative Care or re-certification• Outcomes of interest to payors supporting palliative care service delivery across settings• Data demonstrating depth of palliative care integration in ACO/PCMH/bundling and other risk-bearing health care delivery frameworks• Other1. End-of-Life Perceptions of CHF OutpatientsAllegheny Health NetworkBellevue, PA 15202Team/Contact Information:Mallory S. Ciuksza, MDPGYIII of Internal MedicineAllegheny Health Network474 Teece Ave.Bellevue, PA 15202724-217-3650mallory@ciuksza.comTopics: Communication best practices (e.g., teaching goals of care conversations/advance care planning and implementation of POLST/MOLST)Description:Background: End-of-life (EoL) care planning in heart failure patients remains comparatively understudied. Evidence suggests that heart failure patients infrequently discuss their EoL preferences with their cardiologist. They often also have a poor understanding of their prognosis. In this study New York Heart Association (NYHA) class III–IV heart failure patients were asked whether they had or wanted to discuss their EoL wishes and goals with their cardiologists.Methods: A convenience sample of 56 outpatients with NYHA class III and IV were asked: 1) Do you have a living will, advanced directive or written plan for the end of your life? 2) How often does your cardiologist discussion your EoL wishes or goals with you? 3) Do you want your cardiologist to talk to you about the plan for the end of your life? 4) How long do you expect to live given your current health?Results: Median patient age was 67 and 57.1% were male. Twenty-three (41%) patients had a living will, advance directive, or written plan for the end of their lives. Although the majority (61%) of patients reported that they would like to have a discussion of their EoL wishes and goals with their cardiologist, 35 (63%) reported that they never had an EoL discussion. The majority of patients overestimated their life expectancy; 35 (62%) patients stated that they expected to live more than 5 years. The patients' perceived expected survival time was significantly associated with the frequency with which the cardiologist discusses the patients' EOL wishes and goals (p = 0.04, n = 55).Conclusions: More patients wanted their cardiologist to discuss their EoL wishes and goals during their visit than actually did. Less than half of the patients had a written plan for their EoL. Additionally, most patients overestimate their life expectancy, given the severity of their heart failure.2. Patient Perspectives on Primary Palliative CareAmerican Board of Internal MedicinePhiladelphia, PA 19106Team/Contact Information:Rebecca A. Baranowski, Med, MSSenior Clinical Content ManagerAmerican Board of Internal Medicine510 Walnut Street, Suite 1700Philadelphia, PA 19106215-446-3546rbaranowski@abim.orgTopics: OtherDescription:The American Board of Internal Medicine developed a patient/caregiver questionnaire (PCQ) as part of a new Practice Improvement Module (PIM)® within its Maintenance of Certification program. PIMs are web-based tools that guide physicians through a review of patient data and support quality improvement. The Palliative Care for Primary Care and Subspecialist Physicians PIM focuses on how internists and subspecialists manage the care of patients with progressive chronic conditions or serious, life-limiting illnesses. The questionnaire is intended to provide physicians with feedback on important patient-reported measures related to goals of care; advance care planning; physician communication skills; and patients' self-reported pain, dyspnea, and emotional distress. Patients also provide an overall rating of their physician. The Global Health Scale (GHS) of the Patient Reported Outcomes Measurement System (PROMIS®) was administered as validation criterion for the new questionnaire. For this research study, ABIM partnered with PatientsLikeMe, an online community that provides a forum for discussion, information sharing, and enhanced patient engagement. Correlations between PCQ and GHS scores indicated patients' overall rating of their physician was strongly influenced by perceived mental health and being active socially but less by perceived physical health or overall health status; validity coefficients were moderate.3. Health System–Palliative Medicine CollaborationBaptist HealthJacksonville, FL 32207Team/Contact Information:Tasha M. Schoppee, MSN, RN, CHPNPalliative Care Program CoordinatorBaptist Health800 Prudential Drive, Pavilion 5Jacksonville, FL 32207904-202-3409Tasha.Schoppee@bmcjax.comTopics: Innovative and emerging hospital-based palliative care modelsDescription:In the development of a hospital-based palliative care program, there are various structures that may be implemented. One southeastern health care system is building a palliative care program in which patient care is provided in collaboration with a private medical consultative service. The system has established the roles of Palliative Care Program Coordinator, Palliative Care Chaplain, and Palliative Care Social Worker. The Coordinator has completed a system gap analysis/needs assessment utilizing the Meier and Sieger text. The analysis led to prioritized goals that are being addressed currently. The chaplain and social worker have been assigned to the system's flagship hospital where they are working closely with the palliative medicine group to provide patient care. As the collaboration has been established and grown, it has been beneficial to develop a conceptual model that illustrates the integral workings of all members of the team. Each member continually reviews their identified contributions and tasks. The collaboration, and the conceptual model, are dynamic; shifts are made as needs are identified. (The model and analysis results may be obtained from Tasha.Schoppee@bmcjax.com.)Reference: Meier D, Sieger C: A Guide to Building a Hospital-Based Palliative Care Program. New York, NY: Center to Advance Palliative Care, 2004.4. Umbrella of Palliative Care: A Conceptual ModelBaptist HealthJacksonville, FL 32207Team/Contact Information:Tasha M. Schoppee, MSN, RN, CHPNPalliative Care Program CoordinatorBaptist Health800 Prudential Drive, Pavilion 5Jacksonville, FL 32207904-202-3409Tasha.Schoppee@bmcjax.comTopics: Methods of training in primary/generalist palliative care (e.g., palliative care training for hospitalists and unit nurses in communication and symptom management)Description:One of the challenges faced by providers of upstream palliative care is that our efforts are often confused with hospice care. Meaningful education is required to clarify the components of the work. Fleshing out the broader specialty of palliative care requires demonstrating the point of implementation, the domains of care, the benefits realized by recipients of the care, and the manner by which it may flow into care at the end of life. In response to the common confusion and the needed clarifications, a conceptual model and framework have been developed. This evidence-based visual depiction of palliative care has been utilized as an effective tool for communication and education with administrators, physicians, nurses, social workers, chaplains, and other professionals in both acute care and hospice environments. (The model, framework, and full list of references may be obtained from Tasha.Schoppee@bmcjax.com.)5. Enhancing Palliative Care Delivery: A Hospitalist–Palliative Care Service PartnershipBaptist Hospital, Inc.Pensacola, FL 32501Team/Contact Information:Kelly C. Markham, LCSWPalliative Care CoordinatorBaptist Hospital, Inc.1000 W. Moreno St.Nursing AdministrationPensacola, FL 32501850-469-3739kelly.markham@bhcpns.orgTopics: Innovative and emerging hospital-based palliative care modelsDescription:Following our team's attendance of PCLC at VCU Massey Cancer Center, we formulated a strategic plan to add physicians to our palliative care service. This was achieved through a partnership with Baptist Medical Group, the health system–owned physician group and the Palliative Care Service, operated by the hospital. The Medical Group bears the financial responsibility to fund the physician positions and receives the income from their billing activity. The hospital funds the salaries of the nurse and social worker. It is able to reap the benefits of the cost savings achieved through the Palliative Care Service. In order to begin this partnership, the palliative care team was challenged to demonstrate measurable benefit to both patients and the organization. A dashboard was devised measuring cost savings based on the top-four most frequently occurring palliative care patient diagnoses. In addition, quality measures, patient satisfaction, and consults per month are calculated. The number of referrals has increased between 10% and 40% over the previous year's monthly rate. Addition of the hospitalists to our service has resulted in an affirmative response from physicians, nurses, and staff members. Most importantly, the feedback from patients and families has been overwhelmingly positive.6. Examining the Effect of an Embedded OPC for COPD PatientsBon Secours St. Francis Health SystemGreenville, SC 20601Team/Contact Information:Tracy Fasolino, PhD, FNP, ACHPNPalliative Care Nurse PractitionerBon Secours St. Francis Health System317 St. Francis DriveGreenville, SC 20601864-888-7158tracy_fasolino@bshsi.orgTopics: Innovative and emerging community-based palliative care models (e.g., home/office/clinic/long-term care)Description:Clinic-based palliative care for patients with advanced chronic obstructive pulmonary disease and heart failure holds tremendous promise. Our team designed the model of care for an embedded Outpatient Palliative Care Clinic (OPPC) within a pulmonary practice. We utilized the existing office staffing in the pulmonary practice to support the OPPC initiative. Patients were referred to the OPPC from the inpatient palliative care team, hospital case managers, pulmonary physicians, and transition of care appointments. During the 112 scheduled office hours (over a 6-month period), board-certified hospice and palliative care MDs and NPs completed 83 visits for 57 patients. The average age of the patients was 73 years, with twice as many male as female patients. The primary reason for referral was goals of care followed by symptom burden management. The impact of the embedded clinic on the pulmonary practice included a reduction of office visits by 53 and a reduction of triage phone calls by 92. Of the 57 patients enrolled in the OPPC, only 5 patients were readmitted to the hospital and 3 patients were seen in the Emergency Department. Twenty-three of the 57 patients enrolled into hospice services during the index appointment with OPPC.7. Educating Staff through a System Palliative CollaborativeBon Secours Virginia Health SystemRichmond, VATeam/Contact Information:Aimee Schubert, RNPalliative Nurse NavigatorBon Secours Virginia Health System5855 Bremo Road MOB North, Suite 408Richmond, VA804-288-2673Aimee_schubert@bshsi.orgProject Members:Leanne Yanni, MDMedical DirectorTopics: Methods of training in primary/generalist palliative care (e.g., palliative care training for hospitalists and unit nurses in communication/symptom management) (PCP)Description:Providing unparalleled palliative care is part of our health system strategic quality plan. This requires all staff develop competencies to deliver primary palliative care within their scope of practice. A system-wide approach ensuring staff competencies in primary palliative care through education and developing standardized policies and procedures was needed. Buy-in was obtained from executive administration. Key representatives from hospitals, medical home, hospice, home health, case management, and senior services were identified. Weekly calls led by palliative RN with set agendas began and the collaborative was integrated in system-shared governance structure. A Share point site organizes educational handouts, power points, and articles. Initiatives include system polices for palliative care, end of life, and primary palliative education. Needs assessments were reviewed. Curriculum included: overview of palliative care, advanced care planning communication with case studies and work groups, and symptom management. Pre and post-tests were implemented, followed by a 3-month post-questionnaire. Evaluation data tracked include: appropriate referrals for palliative care service, completion of advance medical directives, and identified HCAHPS questions. Challenges include scheduling educational sessions and ensuring key representation. Planning a best practice symposium across the system for those who received education and expanding education focus to include transition of care.Objectives:• Describe the key steps for success in creating a system-wide palliative collaborative.• Describe three potential barriers to successful collaborative efforts and completing primary palliative education.• Identify two techniques for obtaining executive administrative leadership buy-in.Our palliative team has just been certified at three of the six hospitals implementing this initiative and was the first health care system to have done this. The reviewer said this was a best practice in implementation of primary palliative care and creating enthusiasm and a systemized culture and the reviewer had not seen this in any other health care system she had reviewed.One of our nurses at one of the hospitals was recognized as nurse of the year from ELNEC because of the amount and quality of education being done through the work of the collaborative.The collaborative will also be working on system health stream modules for palliative care and heart failure along with primary palliative care in specialized settings. Additional future education will be focused on the outpatient settings to assist physicians and nurses to begin planning and begin communication for ACP. The next major step for the collaborative this year is integration of and implementation of POLST, to include a large-scale education and training for facilitators, a website, and policies.8. Learning Together: The Palliative Care Action CommunityCalifornia HealthCare FoundationOakland, CA 94612Team/Contact Information:Kate O'Malley, RN, MSSenior Program OfficerCalifornia HealthCare Foundation1438 Webster St., #400Oakland, CA 94612510-587-3181komalley@chcf.orgTopics: Regional and national palliative care initiatives (e.g. statewide coalitions/political advocacy)Description:As health care organizations seek to improve care for people with serious illness across the care continuum, interest in community-based palliative care (CBPC) services is growing. Although many organizations acknowledge the need for such services, opportunities to learn practical information about providing palliative care in clinic, home, and distance (telephonic) settings have been scarce.In the California HealthCare Foundation's (CHCF's) Palliative Care Action Community (PCAC), 21 CBPC provider organizations participated in learning sessions focused on clinical, operational, and measurement issues. Through these collaborative activities, teams discussed approaches to common challenges and practical details about running their programs. As a result, we will share descriptive data on staffing models used by PCAC teams, promising practices for addressing care delivery issues such as partnering with referring providers and managing care transitions, approaches to quantifying opportunities for expanding CBPC services, and specific quality and operational aims that teams achieved in the course of the year. We will also describe resources developed through the initiative, including a comprehensive Field Guide addressing issues central to CBPC program development/management and promising practices for addressing these issues; tools for planning and evaluating services; and an online course that teaches best practices for interdisciplinary documentation in palliative care.9. Person-centered Care: Considerations for a Health Plan-based Palliative Care ProgramCambia Health SolutionsPortland, OR 97201Team/Contact Information:Torrie Fields, MPHProgram Director, Serious Illness and Palliative Care ServicesCambia Health Solutions1625 S.W. 1st Ave.Portland, OR 97201503-721-4064Torrie.Fields@cambiahealth.comTopics: Outcomes of interest to payors supporting palliative care service delivery across settingsDescription:Cambia Health Solutions has implemented a health plan–based serious illness services program for the 2.2 million members we serve, with an approach focused on respecting the patient's wishes, from diagnosis to completion of life. This program puts the patient at the center while remaining inclusive of the entire health care community. New health care services, benefits, training, and education have been created to ensure the entire health care system is engaged in putting the patient and his or her loved ones at the center—supporting the individual and family in their medical, psychosocial, behavioral, and spiritual needs. In addition, we provide necessary support and resources to caregivers and loved ones dealing with the serious illness of a loved one or in need of grief or bereavement counseling. Cambia has focused its efforts in integrating five main areas: benefit expansion, specialized care management, community and member engagement, provider reimbursement and training, and caregiver support. This presentation will provide our framework and implementation of this program, providing a structure for other payors to use in development of palliative care initiatives. We will represent initiatives within and outside of our Accountable Care Organization agreements. Example metrics and baseline statistics will also be presented.10. A Palliative Care Pathway to Educate and Improve Hospitalists' and Emergency Physicians' Palliative Care SkillsCEP AmericaEmeryville, CA 94608Team/Contact Information:Jeffrey Frank, MD, MBAProgram Director of Quality-Hospitalist Practice LineCEP America2100 Powell St., Suite 900Emeryville, CA 94608510-704-3949jeffreyfrank@cep.comProject Members:Shauna Conry, MDSabiha Pasha, MDTrue McMahan, MDPrentice Tom, MDTopics: Methods of training in primary/generalist palliative care (e.g., palliative care training for hospitalists and unit nurses in communication and symptom management)Description:Background: Improving the palliative care (PC) skills in emergency and hospitalist physicians can help mitigate the shortage of certified HPM providers in hospitals.Setting: CEP America (CEP) is an acute care staffing company providing 15 hospitals with integrated emergency and hospitalist programs and 83 emergency department–only sites.Intervention: CEP initiated a Palliative Care Pathway educating and improving physicians' PC skills, and developing site-specific materials of available hospice and PC services.Pathway Goals:1. Improve competencies in palliative and end-of-life care for emergency physicians and hospitalists.2. Improve communication between emergency physicians and hospitalists to enhance coordination of care.3. Increase referrals to PC and hospice.Pathway Components:A. Leadership team of PC chair, content experts, and administrative team: 1. Develop PC pathway, online materials, workshops, and clinical materials.2. PC content experts support site champions.B. Site PC champions roll out pathway at their sites: 1. Engage hospital's leadership to support pathway and collect PC/hospice referral metrics.2. Develop site-specific PC/hospice resource grid.3. Educate site partners.11. Cerner's Electronic Palliative Care ProgramCerner CorporationKansas City, MO 64117Team/Contact Information:Hannah Luetke-Stahlman, MPAProgram LeadCerner Corporation2800 Rockcreek Pkwy.Kansas City, MO 64117816-835-2107hannah.luetke-stahlman@cerner.comTopics: Using technology to improve efficiency and outcomes (PCP)Description:Cerner recognizes a need within the industry to electronically identify, engage, and manage palliative care patients. The program has three main objectives: 1) Early Identification and Stratification—Cerner's teams of designers have developed an identification algorithm that fires based on specific diagnoses and symptoms, alerting your medical staff when a patient may benefit from palliative care. The algorithms stratify these patients based on disease burden, utilization of the health system, and overall health care expenditure; 2) Improve Quality of Care and Life—Cerner's program supports documentation of multidisciplinary team meeting notes providing a holistic approach to patient care. As a result, care teams and providers are able to accurately manage symptoms, support the patient's hope, and coordinate their care as it best supports the patient and his or her family. Joint Commission 2014 certification guidelines have also been taken into consideration to support palliative care programs in achieving quality measures and best practices; and 3) Manage Across the Continuums—Cerner's palliative care program improves the ongoing reassessment and adjustment of the patient's plan of care as the condition warrants across venues. Patient goals and plan of care are established within the acute setting and remain with the patient as he or she transitions back home or to the extended care and/or hospice setting. Communication among all care team members is improved and patient engagement is reinforced through the Member Portal. A Work List has been created so that care teams and providers can manage their palliative care patients and needs in real time; all while improving the quality of life for both patient and family.Objectives:1. Identify and describe the electronic content and core components of Cerner's palliative care program.2. Analyze the efficiency and effectiveness of an automated palliative care work flow.3. Self-reflect on how technology can impact your palliative care processes and program.12. Building a Strong Counseling Foundation for Pediatric Palliative Care ServicesChildren's Hospital of Illinois at OSF Saint Francis Medical CenterPeoria, IL 61637Team/Contact Information:Laura Sollenberger, MA, LCPC, NCC, FTCounseling Supervisor, Pediatric Supportive CareChildren's Hospital of Illinois at OSF Saint Francis Medical Center530 N.E. Glen Oak AvenuePeoria, IL 61637309-624-9631laura.m.sollenberger@osfhealthcare.orgTopics: Pediatric palliative care program development including combined adult/pediatric models (PCS)Description:An incident analysis of children admitted to our institution with diagnoses typically receiving palliative care services showed that over 1000 families annually could potentially be served by a pediatric palliative care program. The foundation of the team is the counseling component. The pediatric supportive care counseling team consists of 1 clinical supervisor and 3.5 clinical counselors who are all credentialed in thanatology through ADEC. The team works collaboratively with a part-time perinatal support coordinator and members of the medical team to provide patient and family support both in the hospital and in outpatient settings. CAPC Automatic Diagnostic Triggers for children were chosen as criteria to drive counseling referrals and any team member may refer for counseling. Counseling is introduced at diagnosis and services are provided for as long as patients and families need counseling support. Bereavement care is provided for families experiencing the death of a child. In the first 3 years, counseling and bereavement support was provided to approximately 800 families. Support and education sessions for staff were also implemented. Results of family and staff satisfaction surveys indicate tremendous satisfaction with counseling support services.Objectives:1. Identify the initial development stages of pediatric supportive care programming at Children's Hospital of Illinois (CHOI).2. Describe challenges and successes in program development.3. Describe the counseling component of pediatric supportive care at CHOI.At this time, we are in the process of building our medical consultation service as the other component of our palliative care team. Financial limitations have forced us to suspend the pursuit of a palliative care–boarded MD and APN until 2015. Starting our hospital supportive care programming first with family and staff counseling has allowed us to rapidly establish a firm base of service provision, which will be enhanced by the addition of a medical consultation service.13. Hospital-based Clinical Massage Training ProgramCommunity College of Rhode IslandNewport, RI 02840Team/Contact Information:Regina Cobb, MSW and Licensed Massage TherapistProgram DirectorCommunity College of Rhode IslandOne John Chafee Blvd.Newport, RI 02840401-851-1672rmcobb@ccri.eduTopics: OtherDescription:We are advocates for massage therapist clinical oncology massage education, skills, knowledge, and research needed to meet the changing health demands of the growing population of cancer patients and survivors. By promoting and embracing this platform, and using the tools provided, we know that massage therapists will be able to enhance and protect the health and well-being of each client/patient who is on the healing journey of cancer and its secondary diseases. Massage therapists will also be prepared to work in a hospital/clinical/medical environment and expand their practices into the palliative care direction of the health care industry.The hospital-based massage therapy program offers specific oncology massage training. It provides all the requirements you need to address the changing health-related conditions of clients/patients dealing with cancer and the secondary ailments/conditions associated with the disease.This hands-on course offers the unique experience of working in one of two major medical facilities in New England. The advantage of this program is that you will have the opportunity of working directly with patients who are receiving chemotherapy or radiation, recovering from surgery, or hospitalized for acute care illness. The patient interaction is extremely beneficial in helping you understand the experiences of working in a hospital setting and applying critical thinking skills in this clinical environment.14. The Birth of CompassionNet's Perinatal Palliative Care Program—a Community-based Approach to Perintal Palliative CareCompassionNet–Lifetime CareRochester, NY 14623Team/Contact Information:Alyssa Gupton, LCSWAssistant Director of Operations and Family ServicesCompassionNet–Lifetime Care3111 Winton Rd. SouthRochester, NY 14623585-214-1333alyssa.gupton@lifetimecare.orgProject Members:Lauren Zwetsch, PNPTopics: Innovative and emerging community-based palliative care models (e.g., home/office/clinic/long-term care) (PCS)Description:CompassionNet is a community-based pediatric palliative care program that supports families facing potential perinatal and infant loss due to a diagnosis in utero that is potentially life threatening. CompassionNet provides in-home support while partnering with hospital providers to address physical, psychosocial, emotional and spiritual needs.Through our community-based program, we recognize that these families have many unique needs and the value of identifying, validating, and responding to these needs as early in the pregnancy as possible.We will illustrate the details of why and how our perinatal program fulfills this need, benefiting both families and the medical community by addressing the following topics: • How and why CompassionNet started our perinatal program and who we serve.• Interdisciplinary team roles and collaboration.• How CompassionNet's partnership with community hospitals helps balance and save resources.- Spe