Coordinating Care Benefits Patients and Families

To promote improved end-of-life and palliative care, The Duke Endowment has awarded more than $9.3 million since 2000 to help build inpatient and residential hospice facilities and develop palliative care programs.

Insights

Hospitals, palliative care programs and hospice facilities play key roles in providing end of life care to patients in the Carolinas. Strengthening palliative care programs, in particular, helps to coordinate services, as these programs often link hospital and hospice care. We invite others to use these findings as a starting point for their own efforts.

• The hospice and palliative care field continues to evolve. Interdisciplinary teams provide coordinated care that helps to manage pain and symptoms, provide for spiritual needs, navigate the health care system and guide end of life decisions. Teams include doctors, nurses, nurse practitioners, social workers and chaplains.
• Hospitals provide acute and intensive medical services for the patient, while hospice facilities and palliative care programs provide specialized care to meet patient and family needs at the end of life. Hospitals and hospice agencies often collaborate to provide comprehensive care, ranging from clinical services in the hospital to care in the home or in hospice facilities.
• Palliative care increasingly serves to link more traditional medical care with hospice care as appropriate, although palliative care can also be provided with curative and life-prolonging treatments regardless of life expectancy.
• Patient choice is critical in hospice and palliative care, as is providing holistic support for the patient and family members.
• New generations of medical professionals are being taught to recognize the value of hospice and palliative care as an alternative to traditional medical care, which focused on curative approaches. Hospice and palliative care are becoming integrated as part of a formal medical education.
• Because the demand for palliative care providers exceeds supply, the need for training grows.
• Palliative care programs often serve as the first step for patients who later choose to receive hospice care in their last days.
• Palliative care programs, by using an interdisciplinary approach, may help decrease overall medical costs by better managing patient care and reducing unnecessary and sub-optimal use of hospital services.

Impact

Hospice and palliative care projects in the Carolinas, including those funded by The Duke Endowment, have measurably improved end of life care.

Increasing Capacity and Use

Between 2000 and 2006, the number of hospice beds in the Carolinas increased from 165 to 331. Occupancy rates increased from 75 percent to 90 percent during this same time.

Improving Patient and Family Satisfaction

Through palliative care programs, hospitals and other organizations have improved pain and symptom management for patients, as well as reduced operating costs due to increased efficiency in coordinating care. Patients and their families also have reported more satisfaction with the support received through palliative care. All of the partner organizations receiving grants from The Duke Endowment have incorporated the programs into their operating budgets, a mark of their commitment to these services.

Connecting Knowledge and Action

A database to collect and manage information from palliative care providers in the Carolinas was piloted by Four Seasons Hospice & Palliative Care in Hendersonville, N.C., with support from The Duke Endowment. The database, which continues to expand, provides detailed information for providers to use as they improve care, set benchmarks and develop targeted initiatives.

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Vice President
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