Cooper Green Hospital
"Balm of Gilead"
Birmingham, Alabama's Cooper Green Hospital has established a comprehensive palliative care program, including its own 10-bed inpatient palliative-care unit called The Balm of Gilead, after a Gospel song about a healing salve. Seventy percent of patients served are African American. The project is nurtured by generous support from the city's churches and business community. In addition, the project provides training for medical residents, interns, and medical students on rotation. Staff from the Balm also conducts monthly in-service training for students at the University of Alabama at Birmingham and in area nursing homes.
Henry Ford Health System
"Enhancing Communication for Improved End-of-Life Care"
The Henry Ford Health System in Detroit is expanding its state-of-the-art computerized record system to include patients' preferences and end-of-life plans. Soon, more than 1,100 doctors and 3,000 nurses within the system's hospitals, home health agencies, hospices, and nursing homes will be on the same page when it comes to advance directives. In collaboration with Michigan State University, the program is developing an interactive CD-ROM that is an invaluable resource to patients and families. In a highly user-friendly format, the Completing a Life CD answers questions and offers sage advice from clinicians and other patients and families who lived with illness and confronted life's end.
Mount Sinai School of Medicine
"Integrating Community Case Management and Palliative Care"
Mount Sinai School of Medicine in New York is partnering with Franklin Health, Inc., a large case-management organization, and Blue Cross/Blue Shield of South Carolina to bring consistent, high-quality home care to the seriously ill. This project integrates advance care planning and symptom management to high-risk homebound Medicare patients with life-limiting illnesses. It is comparing patients' satisfaction, quality of care and utilization of resources.
Sutter VNA and Hospice
"CHOICES: Comprehensive Home-Based Options for Informed Consent about End-Stage Services"
This program is a collaboration of the Sutter Visiting Nurse Association (VNA) and Hospice and North American Medical Management, a managed-care organization. The program began by assuring physicians that they could refer patients for palliative care without having to withdraw life-extending care. A nurse-practitioner and a social worker team up to coordinate care in each patient's home. Careful advance-care planning and individualized plans of care include preparations for potential crises. The CHOICES team is available 24 hours a day, seven days a week to respond to, avert or control acute problems that would otherwise result in ambulance trips and hospitalizations.
University of California, San Francisco
"Comprehensive Care Team"
Researchers at the University of California - San Francisco School of Medicine's Collaborative Innovation in Primary Care Program and the Hospice by the Bay are conducting a controlled trial to evaluate a Comprehensive Care Team Program in which palliation of symptoms and reasonable curative attempts are pursued simultaneously. Health care is not viewed as a war against death, and comfort care is not seen as an "all-or-nothing" choice. A team of doctors, nurses and social workers provides comprehensive care and family caregiver support for seriously ill outpatients who are near the end of their lives. Using a case-management model, the program draws heavily on local volunteer support services, faith communities, and social agencies. The project assesses the impact made by the team on patient quality of life, level of symptom control, psychosocial and spiritual well-being, advance care planning, and health-care utilization and cost.
University of Pennsylvania, School of Nursing
"Palliative Care in Nursing Homes"
The University of Pennsylvania School of Nursing has teamed with Genesis ElderCare, the third largest long-term care provider in the United States, to alter the culture and process of dying in several Maryland nursing homes. The project's teams, which are composed of all levels and types of nursing home personnel, meet weekly to identify patients appropriate for palliative care. They review advance care directives and monitor the effectiveness of palliative interventions. Staff are trained and encouraged to honor and nurture residents as whole persons. In addition, they have developed a training program for nursing-home staff that includes a "non medical palliative- care workshop" on the spiritual, psychosocial, and bereavement aspects of care.
Volunteers of America, Inc
"Guiding Responsive Action for Corrections at End-of-Life (GRACE)"
In this project Volunteers of America brings together wardens, clinicians, pastors, attorneys, and inmate advocates to assess the changes needed in end-of-life care in prisons and to develop standards of hospice and palliative care for the nearly 3,000 people who die in prisons each year in America. Prison hospice demonstration programs have begun in New York, North Carolina, Oregon and Texas. In Phase II of this project, those participating are enhancing the palliative care programs at the four demonstration sites, disseminating standards of palliative care in correctional settings, promoting palliative care through the project's resource center and conducting a national conference to exchange information and dialogue about end-of-life care issues in prisons.
Cooper Green Hospital
Henry Ford Health System
Mount Sinai School of Medicine
University of California, San Francisco
University of Pennsylvania, School of Nursing
Sutter VNA and Hospice
Volunteers of America, Inc.
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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.