Background: Promoting Excellence in End-of Life Care, a national program of The Robert
Wood Johnson Foundation, funded 22 demonstration projects representing a wide range of
health care settings and patient populations to develop innovative models for delivering palliative
care that addressed documented deficiencies in the care of patients and families facing
the final stage of life.
Objective: To determine the practicality (feasibility of development and operation as well
as acceptance by stakeholders) of new models of care and to determine the impact of the models
on access to, quality of and financing for palliative care.
Design: The program cannot report scientifically rigorous outcomes, but the grant-funded
projects used a variety of methods and measures to assess acceptance of new models and their
impact from the perspectives of various stakeholders, including patients and their families,
clinicians, administrators and payers. While it is not possible to aggregate data across projects,
the data reported to the Promoting Excellence national program office were used to describe
program impact with respect to the practicality of palliative care service integration
into existing clinical care settings (feasibility and acceptance by stakeholders), the availability
and use of palliative care services (access), quality of care (conformance to patient expectations
and accepted clinical standards) and costs of care.
Settings and subjects: The 22 projects provided services in urban as well as rural settings,
in integrated health systems, hospitals, outpatient clinics, cancer centers, nursing homes, renal
dialysis clinics, inner city public health and safety net systems and prisons. Populations
served included prison inmates, military veterans, renal dialysis patients, Native Americans,
Native Alaskans, and African American patients, inner-city medically underserved patients,
pediatric patients, and persons with serious mental illness patients.
Results: Hosting or adopting institutions sustained or expanded twenty of the 22 models,
and feedback from all stakeholders was positive. Project sites developed and utilized new
palliative care services and addressed quality through implementation of new standards and
clinical protocols. Costs of care, where they could be assessed, were unaffected or decreased
for project patients versus historical or concurrent controls.
Conclusions: The 22 Promoting Excellence in End-of Life Care projects demonstrated that
by individualizing patient and family assessment, effectively employing existing resources and aligning services with specific patient and family needs, it is possible to expand access
to palliative services and improve quality of care in ways that are financially feasible and acceptable
to patients, families, clinicians, administrators, and payers.
