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Compassionate Support for Dying Patients: A Model for Quality Care

The .CALL. Care Project, initiated in 1994 in Oregon, focuses on providing compassionate care for individuals facing life-threatening illnesses. With a coalition of 14 healthcare organizations across 49 states, this project emphasizes continuity of care, effective service linkages, and the evaluation of care from multiple perspectives. The program addresses physical, emotional, spiritual, and relational needs while promoting knowledge transfer within healthcare systems. By creating adaptable services and improving patient and family experiences, the project aims to enhance the quality of care during the dying process.

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Compassionate Support for Dying Patients: A Model for Quality Care

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  1. CALL Care Project Supportive Care of the Dying: A Coalition for Compassionate Care www.careofdying.org

  2. Current Sphere of Influence • Started in 1994 in Oregon • Funded by system member dues and small grants • 14 Committed Systems / Organizations • Health Care Presence in 49 state

  3. Project as Natural Evolution • Living and Healing During Life Threatening Illness • Organizational Assessment • AICC training

  4. Purpose • Demonstrate a continuity of care and quality improvement model building on strengths of the organization and community • Evaluate the program effectiveness from the individual, bereaved family and system perspectives

  5. Comprehensive • Physical, emotional, spiritual and relationship focus • Patients and families • Various life - threatening disease diagnoses

  6. Adaptable • Flexible over time for person and caregiver • Link services • Develop services which are currently unavailable • Accessible within a variety of funding or reimbursement strategies

  7. Longitudinal • Progressive life threatening illness • Life expectancy may be unknown • Services available across a variety of care delivery sites - without disruption

  8. Life - Affirming • Focus on goals • Assist the person and caregiver to live fully • Re - assess as illness limits life

  9. Timeline / Funding for each site • 18 month project • Started August 2001 • Completion February 2003 • Site Grant Funds • To be used for Project Coordinator • Cannot be used for Clinical Care salary • $25,000 combined RWJF and Coalition

  10. 12 sites • Differing cultural and demographic characteristics • Promote knowledge transfer within and between health systems • Project sponsored by Mission Leaders and approved by CEO

  11. Start - Up Challenges • Organization ownership change • Local IRB review and standards • Personnel changes • Operations level support

  12. Positive Experiences • Expand views of palliative care services • Links stronger in community • Focus on out patient services / specialty clinics • System leaders championing the initiative

  13. Diagnosis Cancer / Oncology patients CHF / Cardiac Disease patients classification of stage III or IV COPD / Respiratory Failure Dementia Inclusion Criteria Any stage IV stage cancer Ejection Fraction of < 25 or NY state Heart Association O2 needed in order to perform ADLs and / or Karnofsky score of <50 Stage > 6 on FAST functional scale or not eating Participants(30-50)

  14. Products • Establish longitudinal benchmark data recognizing successful practices • Produce a record of the development of site specific projects and learnings • Compare learnings across sites

  15. Outcomes • Improved experiences for patient and family caregiver • Cost effective linkages and services • Reimbursable services • Ongoing models developed locally • Knowledge transfer

  16. System versus Individuals • Healthcare professionals experience the system and individuals • Patients and families experience the individual and the system

  17. Goal for Care • “I am completely satisfied with the care….I am at peace with my fate…..My favorite quote is “do not worry about tomorrow, God is already there.” • “”Death is not a failure; for me a failure would be to be unable to support the patients and family in the dying process.”

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