Current State and Next Steps for Specialty Palliative Care


Wui-Leong Koh, MD; Daniel Johnson, MD, FAAHPM

Introduction: Despite growing evidence that demonstrates the many benefits of Specialty Palliative Care (SPC), access to high-quality, specialty-level support across inpatient and outpatient settings remains highly variable. Most Regions lack a standardized approach to the identification and assessment of seriously ill members with the highest risk of having unmet physical, emotional, practical, and/or spiritual needs. Even in Regions with more consistent access to SPC services, referrals to specialty support are variable and often late during the course of illness.
Methods: The SPC National Quality Initiative (NQI) aims to transform the way Kaiser Permanente delivers high-quality palliative care support. The National Permanente Quality Leadership, in partnership with the Care Management Institute and regional SPC Leadership, have created an initial roadmap to guide NQI design and implementation.
Results: To date, the National Permanente Quality Leadership has endorsed a six-step framework to facilitate the successful spread of high-quality, integrated SPC support: 1) invest in partnership; 2) agree upon high-risk patient population; 3) negotiate expectations, team staffing, and work flows; 4) incorporate standardized patient-family needs assessment; 5) triage and titrate support on the basis of needs; and 6) measure outcomes, learn, and spread. Initially, this framework will guide efforts to integrate SPC support for patients with serious cancer.
Discussion: The SPC NQI aims to ensure more systematic SPC support for high-risk populations. The NQI will accelerate interregional learning, scale, and spread by exposing SPC gaps and opportunities, driving investments in SPC services across settings, leveraging critical partnerships, and standardizing care delivery and quality measurement.


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