Promoting Excellence : Grantees (Demonstration Projects) : Special Populations

Bristol Bay Area Health Corporation
"Helping Hands"
The Bristol Bay Area Health Corporation established this project, also called Ikayurtem Unatai (Helping Hands in Yup'ik), to provide end-of-life care for 32 Alaskan Native villages throughout a 47,000-square-mile area of Bristol Bay. Native leaders had expressed concern that terminally ill elders were commonly flown to hospitals in Dillingham or Anchorage where they spent the last days of their lives, and ultimately died, far away from their families and villages. The program is working with a medical anthropologist to ensure that training and educational manuals integrate the cultural beliefs of this population. An eight-week "Helping Hands" course for community health aides in routine health care issues and palliative care, plus telephone and radio backup from the physicians and nurses at the health agency in Dillingham, is successfully giving new definition to palliative care in these rural Alaskan homes.

Children's Hospital and Regional Medical Center
"Pediatric Palliative Care Program"
Children's Hospital and Regional Medical Center in Seattle created a system of support and decision-making for families who have children with life-threatening illnesses. A case manager works with each family through the course of the child's illness. Children's Hospital, the Washington Department of Health, the state hospice association, and Washington's two largest insurers, Regence Blue Shield and Premera, are developing flexible benefit strategies to extend health insurance coverage for palliative care during the child's illness.

Department of Veterans Affairs, West Los Angeles Medical Center
"Pathways for Caring"
The U.S. Department of Veterans Affairs, West Los Angeles Medical Center integrates palliative care into its continuum of services for veterans with lung cancer, advanced congestive heart failure, chronic obstructive pulmonary disease, and cirrhosis. Eligible patients meet with a case manager who calls in a palliative team. An individualized "critical pathway" becomes part of the patient's computerized medical record, available anywhere within the West LA Veterans Administration's hospital and outpatient clinic system. The project also brings education in palliative care to doctors, nurses and other clinicians in monthly education sessions.

Massachusetts Department of Mental Health, Metro Suburban Area
"End of Life Care for Persons with Serious Mental Illness"
This project at the Massachusetts Department of Mental Health, Metro Suburban Area, is extending hospice-style care to dying people with long standing severe psychiatric illness. The network's team has worked with researchers at the University of Massachusetts to develop tools for evaluating the competency of these patients to make decisions and to complete advance directives. These assessments become part of each patient's care plan. In addition, the team has encouraged a unique professional exchange: hospice staff learn about the needs of people who are seriously mentally ill, and mental-health clinicians become familiar with hospice and the techniques of high-quality end-of-life care.

Medical University of South Carolina
"Palliative Care Services for Urban African Americans"
The Program in Bioethics at The Medical University of South Carolina and the Center for the Study of Aging is collaborating with Charleston, SC's Enterprise Community to investigate end-of-life attitudes, beliefs and needs among the area's African-Americans. Local hospice programs provide end-of-life care, but most of Charleston's African-American residents do not choose hospice care as they or their loved ones near life's end. Instead, they often die in the hospital, frequently separated from family and friends. Area residents participate in focus groups and structured interviews, providing rich information for the study.

SSM Cardinal Glennon Children's Hospital
"Footprints"
This program, developed by SSM Cardinal Glennon Children's Hospital in St. Louis, includes a statewide network of health care providers to care for children who are dying at home. Working with St. Louis University's School of Medicine, the hospital has created a palliative care team to educate pediatricians, the staffs of community hospitals and area hospices. The curriculum encompasses the principles of pediatric pain control and other palliative services. The project team coordinates care for families at this most critical time in their lives, provides pastoral care, as well as grief support and counseling.

University of California, Davis, School of Medicine
"Simultaneous Care"
The West Coast Center for Palliative Education at the University of California, Davis School of Medicine is assisting physicians and home health personnel to improve end-of-life care in three rural northern California counties. This project regularly uses satellite telecommunications to link the teaching physicians at the university with their rural colleagues. The center is also introducing palliative care services to women in prison in collaboration with the California Department of Corrections. Its Simultaneous Care Program is extending palliative care to patients and families who are usually deemed ineligible for hospice services because they are pursuing life-prolonging treatment. This project brings the palliative care staff into what they've termed "a deep collaboration" with the clinical trials and treatment staff.

University of New Mexico, Health Sciences Center
"When Cure is No Longer Possible"
The University of New Mexico's Health Sciences Center is building a hospice network in seven rural communities within three distinct subcultures. Included in the project is the Zuni Home Health Agency which established the nation's second Native American hospice program. Interdisciplinary teams work to upgrade medical, ethical, spiritual, and psychosocial aspects of dying and caregiving while exploring Native American perspectives. An additional project, When Cure is No Longer Possible: A Palliative System of Excellence for Rural New Mexico, created a statewide Center for Palliative Care Information, Referral, and Training that provides assistance and support to rural communities that are interested in developing an integrated palliative care system.

Bristol Bay Area Health Corporation
Children's Hospital and Regional Medical Center
Department of Veterans Affairs, West Los Angeles Medical Center
Massachusetts Department of Mental Health
Medical University of South Carolina
SSM Cardinal Glennon Children's Hospital
University of California - Davis, School of Medicine
University of New Mexico, Health Sciences Center
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Promoting Excellence in End-of-Life Care is a national program of The Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit PromotingExcellence.org for more resources.

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