Promoting Excellence : Sustaining, Exporting & Elevating Grantee Innovations : The PEACE Program

Name of Project: Promoting Excellence in Alzheimer Care Efforts: The PEACE Program

Institution: University of Chicago (with subcontract to Hospice of Michigan), Chicago, IL

PI: Greg A. Sachs, MD

Abstract (as described by Project staff)
Design, implementation, and evaluation of two different models of providing palliative care to patients dying from dementia. One model focuses on providing palliative care consultation services to patients in nursing homes, patients whose disease severity does not yet clearly qualify them for hospice enrollment. The other model attempts to provide palliative care and supportive services to patients and family members throughout the course of the dementia, following more of a disease management model.

Brief Synopsis of Program Characteristics, Successes and Challenges
The PEACE Program has a unique history. It is a collaboration between the University of Chicago Medical Center (UC) and Hospice of Michigan (HOM). The University of Chicago has established a new institute: The University of Chicago’s Center for Comprehensive Care and Research on Memory Disorders, a major collaboration involving the departments of medicine, neurology and psychiatry. Dr. Greg Sachs, project PI, is co-founding director of the Memory Center. Dr. Sachs was also named Chief of the newly created Section of Geriatrics within the Department of Medicine. These developments will likely have an impact on the long-term success of institutionalizing the PEACE project at UC.

The patient populations and organizational settings of the two components of PEACE are quite different. The Hospice of Michigan component is based in a community hospice serving a largely Caucasian, severely affected (FAST stage 7), institutionalized patient group living in two nursing homes in suburbs around Detroit. The University of Chicago component is located in an academic geriatric practice serving a largely African American, variably affected, mostly outpatient population in Chicago.

Exportable Products/Tools

• The Family Manual is a well-designed and easily exportable care planning and communication tool developed by Hospice of Michigan that could merit broad dissemination.
• “Choice points” developed by HOM staff identify clinical junctures that trigger the need for advance care planning discussions regarding patient goals and treatment options.
• “Drive-time” education tapes have been developed by Kathleen Murphy, MD, former medical director of the HOM component. These cassette tapes capture Dr. Murphy’s lectures and represent a potentially powerful tool for busy clinicians who would benefit from listening and learning as they travel.
• Protocols developed by the University of Chicago addressing palliative care for patients with dementia.

Policy Issues
Project staff feel it is important to highlight ways in which regulatory oversight and reimbursement patterns exert pressures that are, at times, at variance to the needs and goals of advanced dementia patients and their caregivers.

Communications
The HOM Family Manual and educational tapes are tools that will benefit other providers and institutions; collaboration with professional organizations, including the Alzheimer Association, may offer a good source of support to complete and disseminate these tools.

Generalizing the Model
There are various approaches to embedding the concept of the PEACE project into other national venues, including:

• The “institutionalization” of a hospice team within the walls of long-term care facilities as a potential means of integrating restorative and palliative care for residents;
• The development of academic models, such as a Professor of Nursing Home Medicine, similar to programs in the Netherlands; and
• Build programs that use trained, supervised volunteers to supplement care and diminish stress of overworked nurses aides.

When asked what it would take to generalize their model, Dr. Sachs replied:
“The need to study our model efforts in practices that are not already committed to improving end-of-life care, where non-geriatricians are in charge of the patients care.”

Words of Wisdom from the Project
When asked what advice they would offer an institution attempting a similar project, project staff replied:

• Collect less data,
• Focus more on rapid change cycles, and
• Collect more financial data that can persuade institutions and others that it is worth their while to pay the upfront costs of additional staff and programming.

[ Go Up ]

Promoting Excellence in End-of-Life Care is a National Program Office of The Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying persons and their families. Visit PromotingExcellence.org for more resources.