Developing Successful Palliative Care Teams in Rural Communities: A Facilitated Process.

Background: Developing palliative care (PC) programs in rural settings is challenging due to limitations on training, staff, resources, and reimbursement. Employing established frameworks and processes can assist rural communities in developing quality PC programs. Objective: We sought to employ a facilitated community-centric planning process to guide several rural community teams across three states in the United States to support PC program development. Materials and Methods: This is a prospective, observational, quality improvement initiative implemented over 18-24 months. Results: A total of 17 community teams volunteered to participate in the process and completed initial assessments that identified gaps in clinical PC skills in several aspects of PC, including bereavement care, care continuity, pain and symptom management, and communication with family. Teams also identified barriers to optimizing PC for patient and families, including limited community awareness, poor reimbursement mechanisms, lack of resources and experience with PC, and inadequate care coordination. All 17 community teams developed and worked on implementation of a community-specific action plan to develop PC services. However, due to staff capacity limitations imposed by COVID-19, only eight communities completed a follow-up assessment in late 2020. These teams showed some improvement in knowledge of multiple PC domains as a result of the process and provided qualitative feedback indicating that the process was helpful in building capacity to offer needed services and developing the skills and workflows necessary to support delivery of PC. Conclusion: This unique development process can help rural communities organize, develop, and sustain PC programs and overcome common barriers to providing PC.

Palliative Care in Rural Minnesota: Findings from Stratis Health's Minnesota Rural Palliative Care Initiative.

Palliative care, which involves managing symptoms, controlling pain and addressing stress caused by a chronic or terminal illness, has been shown to keep patients out of the hospital and allow them to stay home and live more comfortably with their illness. Typically, it is provided by an interdisciplinary team led by a physician trained in palliative medicine. Rural areas have not always had access to such specialists. Yet, today, rural health care organizations are finding ways to create palliative care programs that meet the needs of their chronically ill and aging populations. This article describes a six-year initiative led by Stratis Health to advance palliative care in rural Minnesota. It highlights the work of FirstLight Health System in Mora and describes Stratis Health's Rural Palliative Care Measurement Pilot Project, an effort to develop and test measures for evaluating rural palliative care programs.

Quality Measures for Community-Based, Rural Palliative Care Programs in Minnesota: A Pilot Study.

BACKGROUND: Despite the growth of palliative care programs in many urban areas, palliative care programs remain less common in rural communities. As more community-based programs emerge, particularly in rural areas, it will be important to establish a standard set of quality measures that are useful for improving care and feasible for program evaluation. OBJECTIVES: The study's objective was to identify and field test a standard set of quality measures for rural, community-based palliative care programs that reflect clinical quality, patient and family experience, and impact on inpatient and emergency department utilization. METHODS: A pilot program was conducted to test standardized quality measures for rural, community-based programs. Measures were identified through review of existing measures and input from experts in palliative care and rural health services. The study was carried out in 2012 and 2013 in five community-based palliative care programs from rural communities. A total of 138 palliative care patients were included. Measurements were chart abstraction, patient and family experience surveys, patient-level health care utilization, and program-level operations surveys. Phone interviews with each participating program were performed at the study's end. RESULTS: The participating programs found the measures feasible to collect, and the information they provided aided in assessment, comparison of structure, and process improvement for care delivery. Program staff suggested additional potential measures and expressed their desire to track the measures beyond the pilot time frame. CONCLUSION: The standard measures developed and tested were deemed feasible to collect and useful for all five participating rural, community-based palliative care programs.

Minnesota Rural Palliative Care Initiative: building palliative care capacity in rural Minnesota.

BACKGROUND: Significant gaps exist in the availability of palliative care in rural hospitals and communities, even though rural populations are often disproportionately elderly and chronically ill. Few studies have examined what models of palliative care would be sustainable in a rural community. METHODS: We studied the effects of a novel approach to palliative care program development with 10 rural Minnesota community teams over 18 months. The Minnesota Rural Palliative Care Initiative (MRPCI) included a three-prong framework consisting of community capacity theory, a learning collaborative model, and the National Quality Forum (NQF) Preferred Practices for Palliative and Hospice Care Quality. RESULTS: MRPCI confirmed the feasibility of building palliative care capacity in rural communities using this framework. By the end of the 18 months, all 10 teams had identified a target population, developed and refined an action plan, and included at least two strategies to address community needs or gaps related to NQF preferred practices. Only one community had an existing palliative care program at the start of the MRPCI. During the course of the collaborative, five additional communities built a core team to implement a palliative care program. CONCLUSIONS: Palliative care development is necessary in rural communities, and envisioning a program that combines structure, accountability, customized guidance, tools, and networking across settings is essential for success.

Palliative care in rural Minnesota. Findings from Stratis Health's Minnesota Rural Palliative Care Initiative.

Palliative medicine involves managing symptoms, controlling pain and addressing stress caused by chronic illness. It can help keep patients out of the hospital and allow them to stay in their homes and live more comfortably with their illnesses. Most palliative care programs are found in urban areas, and both national and statewide studies have found a dearth of such services in rural communities. This article describes Stratis Health's Minnesota Rural Palliative Care Initiative, which is bringing representatives from organizations within rural communities together to learn from each other how to provide palliative care services. It also highlightsthe efforts of organizations in four communitiesthat are providing such care and discusses plans for evaluating these and other programs.