Sick To Death > Chapter 3 > Palliative Care at Home
Several innovative programs have developed strategies to improve links between home health care, disease management programs, and hospice and palliative care (National Coalition for Health Care and Institute for Healthcare Improvement 2002). At a Kaiser Permanente facility in southern California, for example, the hospice and palliative-care team worked with staff members from a disease management program to improve end-of-life care (Brumley, Enguidanos, and Cherin 2003). The Kaiser Bellflower program aimed to improve families' satisfaction, increase the number of patients referred for hospice care, reduce the need for 911 calls and emergency room admissions, and identify dying patients earlier in the course of their illness. The program developed a checklist to guide hospice staff during home visits to patients with advanced heart and lung failure. It also worked on outreach to all subspecialty physicians in Kaiser medical centers and encouraged physicians to refer seriously ill patients to hospice while patients were in stable, outpatient settings, rather than waiting for an emergency situation. Finally, the program designated liaison nurses to provide one-on-one training and information to physicians throughout the system. Over an eight- month period, emergency transport calls and unplanned hospitalizations went from four per hundred patients to fewer than two per hundred (National Coalition for Health Care and Institute for Healthcare Improvement 2002).