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Palliative care management: a Veterans Administration demonstration project
Kenneth Rosenfeld1, Jennifer Rasmussen
1The VA Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA. kenneth.rosenfeld@med.va.gov
Journal of Palliative Medicine
|November 19, 2003
Summary
The Pathways of Caring project improved end-of-life care for Veterans with serious illnesses, increasing hospice enrollment and home deaths while reducing hospital use.
Area of Science:
- Palliative Care
- Health Services Research
- Geriatric Medicine
Background:
- The Veterans Health Administration (VA) aims to enhance end-of-life care.
- The VA Greater Los Angeles Healthcare System (GLA) initiated a demonstration project.
Purpose of the Study:
- To evaluate the "Pathways of Caring" program for patients with inoperable lung cancer and advanced heart/lung disease.
- To assess the impact of intensive palliative care coordination on patient and family outcomes.
Main Methods:
- Targeted case-finding for poor-prognosis patients.
- Interdisciplinary palliative assessments.
- Intensive nurse care coordination across providers and settings.
Main Results:
- High rates of advance care planning and hospice enrollment.
- Increased deaths at home and reduced end-of-life hospital/ICU utilization.
- Despite challenges, the program demonstrated measurable success.
Conclusions:
- The "Pathways of Caring" model successfully improved end-of-life care coordination and outcomes.
- The program's success led to plans for institutional-wide expansion.