Hospice and Palliative Care by the VA, beyond the VA

By Shreve, Scott | Generations, Summer 2010 | Go to article overview

Hospice and Palliative Care by the VA, beyond the VA


Shreve, Scott, Generations


Reducing variability in end-of-life care across the expansive VA system has been central to our strategic planning.

The department of Veterans Affairs (VA) has a palliative care program whose strengths are embodied in the VA's longstanding mission statement to "honor Veterans' preferences for care at the end of life." This mission statement has provided a unifying focus for delivery of end-of-life care.

Our program has brought this mission to the bedside through the installation of two palliative care regional leaders in each of the VA's twenty-one regions to oversee and to promote team activities at every facility. Regular and routine reporting of veteran-centric measures focus and align efforts with national initiatives and, most importantly, the widespread sharing of strong practices among palliative care teams allows successes to be readily disseminated across the system.

Reducing variability in end-of-life care across the expansive VA system has been central to our strategic planning. Efforts to reduce variability have been successful. For example, all VA regions now have more than 50 percent of inpatient deaths receiving palliative care services prior to death (versus an average of 33 percent in 2004). Continued efforts to reduce variation in access to quality end-of-life care will be required.

Paramount to the VA's ongoing success is a sustained focus on the care needs of veterans who are approaching the end of life. While the VA's national performance measure results in the Bereaved Family Survey (Casarett, 2008a). address this goal in the near term, healthcare systems are inundated with measures and the VA leadership will need to remain convinced of the substantial value added from palliative care services, even when delivered by nonpalliative care staff.

Overview

The hospice and palliative care (HPC) program in the VA is a network of interdisciplinary palliative care teams in all 153 VA medical centers. Each team is guided by regional palliative care leaders and national program office staff. The HPC program has transformed the culture of care through sweeping changes in policy, legislation, and practice.

Central to these efforts is a focus on meeting the palliative care needs of veterans. The HPC program has made rapid progress toward this goal by reducing variability in access, improving quality, sharing expertise, and facilitating coordination and collaboration between both VA and community providers.

The HPC program addresses the palliative care needs of veterans and their families by integrating palliative care and measuring quality outcomes, educating VA staff and community providers with veteranspecific curricula, and partnering with community hospice programs and nationally respected organizations (such as the Center to Advance Palliative Care and the National Hospice and Palliative Care Organization) to improve the delivery of palliative care for all veterans, whether enrolled in the VA or not.

Inside the VA, the formal palliative care infrastructure began in a 2003 policy that established palliative care consult teams at every facility. These teams are empowered to deliver palliative care and also to share their expertise beyond palliative care providers. Through a nationally connected communication system across the VA, providers have ready access to educational programs in many forms: via annual face-to-face conferences; bimonthly audio conferences on end-of-life care issues; and program-building resources on the HPC Implementation Center's rapidly expanding intranet.

A growing amount of VA palliative care is being delivered by the VA's home-based primary care (HBPC) teams. Home-based primary care provides comprehensive, longitudinal homecare to more than 21,000 seriously ill veterans in their homes each day. Because HBPC targets veterans with advanced illness, 21 percent of veterans enrolled in this program die under the care of an HBPC team (personal communication with Dr. …

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