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Service Delivery Innovation Profile

Palliative Care Nurses in Primary Care Clinics Reduce Hospital Admissions, Increase Use of Hospice and Home Care for Patients Nearing End of Life


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1: Waiting for the Paradigm Shift.
Dr. Rader, in his expert commentary on this fine intervention, suggests that bringing palliative care to primary care is not so much evidence of the value of palliative care, as it is of the failings of the current medical model. He takes this opportunity to expound on the ways in which patients would be better served if medicine was different-- I do not disagree. However, in his arguing for the necessity of a medical paradigm shift, I believe Dr. Rader ignores two things. First, that until that shift happens, there are patients whose (physical, emotional, spiritual) suffering we aren't adequately addressing. They shouldn't need to wait until we professionals clean house to benefit from the principles of palliative care. And second, perhaps palliative care nurses in primary care aren't the "wrong solution" but, as they educate patients and fellow providers alike, a jumping off point for the beginning of the right one?
Jaime Hensel, RN, Friday, December 14, 2012 11:46 am| University; Nurse
2: Hospice Admission Nurse
Dr Rader and Nurse Hensel have commented on this effective innovation to better serve patients suffering from chronic severe illness. I would like to suggest that Dr Rader is correct and Hospice is underutilized and Nurse Hensel is correct and Palliative care nurses in primary care is a jumping off point and that a patients final journey with love is long process rather than a finite end point addressable with one solution.
Christopher O'Loughlin RN BSN PHN, Wednesday, March 26, 2014 6:25 pm| Other; Nurse
3: Clinic Based Palliative RN perspective
In response to both comments and review of Dr. Rader's initial commentary I would like to state that I agree with all of them to some degree. Since starting the Partners Program in 2004 we've encouraged provider education around end-of-life issues and increased utilization of hospice when appropriate and agreeable w/pt and family. We have however made a very positive impact in the lives of our patients/families through our Palliative focused case management interventions and emphasis as well on pt/family education of options. We build trusting relationships over months/years which ease transition to hospice. Our program average LOS (rollup for 2013) on hospice is 93 days, Median LOS is 51 days; we had 300 deaths on hospice in 2013. For the past 3 years 72% of patients on our program have been on hospice at time of death - our goal is 80%. We currently serve approx 1400 in a total of 6 primary clinics and our Cancer Partnership. We still have a ways to go with provider education and a LONG way to go with community education - we're hitting all of them within our county. But in the interim we ARE making a difference - one patient/family at a time!
Velda Filzen, RN, BSN, CHPN-Partners Program Mgr., Monday, April 21, 2014 7:46 pm| Clinic; Nurse
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Original publication: December 18, 2008.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: February 12, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: December 21, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.