Integration of Palliative Care in Rural Communities - PowerPoint Presentation

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Integration of Palliative Care in Rural CommunitiesPat Justis, MA & Stephanie Carpenter, RN, CNOWSHPCO, October 10, 2017

Washington Rural Palliative Care Initiative

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Objectives1. List three characteristics of rural health systems that call for a different approach to palliative care and describe the model proposed for rural integration of palliative services in WA State.2. Describe specific strategies that organizations can use to deliver palliative services to rural communities.

3. Discuss lessons learned to date in a rural healthcare system in rural WA.

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Rural? Comparable data?There are at least six different ways to define rural-and measure health risks and outcomes.County level-used for some purposes but imposes inaccuracies. (31 of 39 counties labeled rural).

We use RUCA for most work which is at census track level or zip code, with 10 codes and 21 secondary codes, four categories.

Urban, suburban, large rural, small rural

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Overall WashingtonDepending on classification system used, 12.3 percent to 16 percent of residents live in rural areas.Also various ways to classify “Frontier” criteria and unit of geography. Most simple= population density of seven or fewer people per square mile

.( Federal Public Law 94-171)

WA: Skamania, Columbia, Garfield, Lincoln, Ferry

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The further you are from a metro area the greater the health disparities…Older and younger with fewer working age adultsPoorerMore obese, more tobacco use

More with unmet medical needs

Fewer with healthcare insurance

Fewer with personal healthcare provider

Fewer with dental care

Fewer utilize preventive care or services.

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The further you are from a metro area the greater……the travel time for home health and hospice teams.

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What are other challenges for rural care delivery?

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Rural RisksLonger waits for specialty services, sometimes primary careRisk of tertiary transfers rip apart families at vulnerable timesLess exposure to palliative services, may be unaware of choiceDisruption from workforce turnover and shortages

Fewer formal community supports for other needs (but often greater informal)

Fiscal sustainability crisis

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There is not enough volume or resources……to support free standing inpatient/outpatient palliative services in every rural community.

The goal: no duplication, filling gaps and coordinating across programs and services

So, what will work and operate in collaboration with home health and hospice agencies?

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Washington Rural Palliative Care Initiativeobjectives

Assist rural health systems and communities to integrate palliative care in multiple settings, to better serve patients and families in rural communities. 

Use the Model for Improvement to test and refine changes and assess measurable improvements to selected process and outcomes measures.

Develop funding models for sustainable services

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Building the visionChartered Palliative Care-Rural Health Integration Advisory Team, Met four times between 10/2016 and 3/2017Composed of rural health early adopters from CAHS and RHCS, experts in palliative care, experts in telemedicine, a rural hospice, associations, DOH, physicians, nurses, care managers, educators and more.

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Rural Palliative Care in MinnesotaStratis Health (Quality Improvement Organization) initiated work on rural palliative care in 2009 and now have about 30 rural communities offering some level of palliative care service.They increased benefits for palliative care in the state.

Their approach is community based and owned.

Wonderful resources below or Google

Stratis Health Rural Palliative Care

http://www.stratishealth.org/expertise/longterm/palliative.html

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Piper Hawley, Bmed, FRPC

University of British Columbia, Head of Palliative Care Division

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The Model

Act

Plan

Study

Do

Palliative Care-Rural Health Integration Advisory Team (PC-RHIAT)

Model Diagram

Begin with in-kind contributions and develop sustainable funding streams

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The Telehealth developmental path…

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Making it concreteA community pilots in their home health agency, offering palliative care consults Volunteer Retired (and not retired) Professionals receive training, ongoing support and supervision to offer home based visits working in tight collaboration with home health and hospice

A primary care Rural Health Clinic team offer primary palliative care and knows how to connect to the community team.

The Critical Access Hospital identifies patients who may benefit from a palliative care consultation and can arrange for that by telehealth or directly to the patient and family for telemedicine.

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Work progress

Training for WA rural health communities

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Our first cohortPullman Regional Hospital-PullmanWhitman Hospital-ColfaxColumbia County Health System-DaytonColumbia Basin Hospital-Ephrata

Jefferson Health Services-Port Townsend

The Lookout Coalition-Twisp

Newport Hospital and Health Services (delayed entry)

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Northwest Rural Health Conference

March 26-28, 2018 Davenport Grand, Spokane

Save the date

 

 

 

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Northwest Telehealth, Northwest Regional Telehealth Resource Center, Family Care Network, Northwest Rural Health Network, Heartlinks Hospice and Palliative Care, Washington Hospice and Palliative Care Organization, Home Care Association of Washington, Newport Hospital and Health Services, Pullman Regional Hospital, Whitman Hospital, Washington State Department of Health State Office of Rural Health, University of Washington (WWAMI, Family Medicine, Palliative Care), Washington State University Elson S. Floyd College of Medicine, Providence Health System, Amerigroup, Washington State Hospital Association, Qualis Health, and Stratis Health

Newly invited members:

Columbia County Health System, The Lookout Coalition, Columbia Basin Hospital, Jefferson Health System

Thanks to the

Palliative Care-Rural Health Integration Advisory Team