Palliative care management: a Veterans Administration demonstration project.
As part of a Veterans Health Administration (VA) commitment to improve end-of-life care the VA Greater Los Angeles Healthcare System (GLA) implemented Pathways of Caring, a 3-year demonstration project targeting patients with inoperable lung cancer and advanced heart failure and chronic lung disease. The program utilized case-finding for early identification of poor-prognosis patients, interdisciplinary palliative assessment, and intensive nurse care coordination to optimize symptom management, continuity and coordination of services across providers and care settings, and support for families. Program evaluation used patient and family surveys as well as reviews of medical records and administrative databases to assess processes and outcomes of care. Despite significant programmatic challenges including organizational instability and evaluation design issues, the program achieved measurable success including high rates of advance care planning, hospice enrollment, and death at home, and low end-of-life hospital and Intensive Care Unit (ICU) use. As a result of its success, the program will be expanded and its care model extended institution-wide.
Rosenfeld
Kenneth
K
The VA Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA. kenneth.rosenfeld@med.va.gov
Rasmussen
Jennifer
J
D006801:Humans; D015141:Los Angeles; D019982:Organizational Case Studies; D010166:Palliative Care / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D019452:Terminally Ill; D014481:United States; D014728:Veterans