title: Palliative Excellence in Alzheimer Care Efforts (PEACE): a program description.
abstract: Hospice is the standard method for providing quality end-of-life care in the United States. However, studies reveal that persons with dementia are infrequently referred to hospice, that barriers exist to increasing hospice utilization in this population, and that patients with dementia would benefit from hospice or hospice-like services earlier in the disease course. The Palliative Excellence in Alzheimer Care Efforts (PEACE) program responds to these deficiencies, striving to improve end-of-life care of persons with dementia and to integrate palliative care into the primary care of patients with dementia throughout the course of the illness. The PEACE program is a disease management model for dementia that incorporates advance planning, patient-centered care, family support, and a palliative care focus from the diagnosis of dementia through its terminal stages. PEACE is coordinated through the primary care geriatrics practice of the University of Chicago. Patients and caregivers are interviewed every 6 months for 2 years, and a postdeath interview is conducted with caregivers. These interviews assess care domains important for the optimal care of persons with dementia and their caregivers. A nurse coordinator reviews interviews and provides feedback to physicians, facilitating enhanced individual care and continuous quality improvement for the practice. Initial feedback suggests patients have adequate pain control, satisfaction with quality of care, appropriate attention to prior stated wishes, and death occurring in the patient's location of choice. Families voiced similar high marks regarding quality of care. This program demonstrates an innovative model of providing quality palliative care for dementia patients and their caregivers.
authors.affiliation: University of Chicago, Section of Geriatrics, School of Medicine, Chicago, Illinois 60637, USA. jshega@medicine.bsd.uchicago.edu
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Shega
authors.forename: Amy
authors.initials: A
authors.lastname: Levin
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Hougham
authors.forename: Deon
authors.initials: D
authors.lastname: Cox-Hayley
authors.forename: Daniel
authors.initials: D
authors.lastname: Luchins
authors.forename: Patricia
authors.initials: P
authors.lastname: Hanrahan
authors.forename: Carol
authors.initials: C
authors.lastname: Stocking
authors.forename: Greg A
authors.initials: GA
authors.lastname: Sachs
mesh_terms: D000544:Alzheimer Disease / Q000451:nursing*; D019985:Benchmarking; D017028:Caregivers; D002641:Chicago; D006801:Humans; D010166:Palliative Care / Q000458:organization & administration / Q000592:standards*; D016730:Program Development; D011787:Quality of Health Care