10 Rural Communities Enhanced Palliative Care Services through the Minnesota Rural Palliative Care Initiative

Published Wednesday, August 3, 2011

Ten rural communities in Minnesota have made advances toward establishing or strengthening palliative care services, through the Minnesota Rural Palliative Care Initiative, an 18-month learning collaborative. The initiative required interdisciplinary community-based teams that spanned multiple health care settings. This experience should strengthen the communities' ability to work together in the future to further transform care delivery.

Palliative care is an interdisciplinary approach to managing serious and advanced illness that centers on relieving suffering and improving quality of life for patients and their families. It customizes treatment to meet the needs of each individual, seeking to relieve pain, anxiety, shortness of breath, fatigue, nausea, loss of appetite, and other symptoms. Practitioners of palliative care help patients and their families understand treatment options, and facilitate effective communication among health care professionals, patients, and family members. Emotional and spiritual support for the patient and family are hallmarks of palliative care.

Stratis Health developed and led the Minnesota Rural Palliative Care Initiative to help address the need for palliative care services in rural Minnesota. UCare funded the project and Fairview Health Services provided supportive expertise in palliative care program development and clinical topics.

Community teams in the following areas participated: Bemidji, New Ulm, Olivia, Red Wing, Roseau, Staples, Waconia, Wadena, Willmar, and Winona.

Models for service delivery to support palliative care programs in rural communities are lacking. Through the initiative, participating communities developed models for service delivery that fit their needs and resource. The models varied widely in the methods of service delivery, such as palliative care services through a home health agency or nursing home or inpatient consultation; the disciplines represented in the interdisciplinary teams, patient focus, such as infusion therapy or physician referred with complex illness; and position for coordinating staff.

Six of the 10 communities were enrolling patients as of April 2011 and providing interdisciplinary palliative care services. The other four developed and/or improved processes to support palliative care, such as advanced care planning or implementing common order sets across care settings to support effective communication and patient transitions.

The Minnesota Rural Palliative Care Initiative provided these insights on the state of palliative care in rural communities:

• External resources and support are needed for rural communities to develop palliative care services.
• Ongoing networking for learning and sharing is critical to sustaining rural palliative care programs.
• New approaches to assessing the cost-benefit value of rural palliative care services are necessary to make the business case for such programs.
• Innovative content delivery mechanisms are needed to spread rural palliative care in cost-effective yet meaningful ways.
• Reimbursement for palliative care services as a covered benefit from payers and insurers is important.
• Palliative care programs and services align well with other efforts to redesign care delivery.

Palliative care is increasingly recognized as an integral part of the care for people of any age with advanced illness and their families. Studies demonstrate positive clinical and financial impacts from providing palliative care services. The clinical care, psychosocial, and spiritual support provided through palliative care services improves the quality of life for patients and their families.

"The 10 communities in this initiative shared a strong desire to improve patient care, collaborating across the silos of departments and organizations to deliver the most compassionate and medically appropriate care," said Jennifer Lundblad, PhD, president and CEO, Stratis Health. "We need more innovative collaboration of this kind to truly meet the medical needs and personal wishes of health care consumers, and to reduce health care costs."

Minnesota Rural Palliative Care Initiative project brief >