Building the Workforce
We Need to Care for
People with Serious Illness
PROCEEDINGS OF A WORKSHOP
Kaitlyn Friedman, Joe Alper, and Laurene Graig, Rapporteurs
Roundtable on Quality Care for People with Serious Illness
Board on Health Care Services
Board on Health Sciences Policy
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
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This activity was supported by Contract No. HHSN2632018000029I (Task Order No. 75N98019F00851) with the National Institutes of Health’s National Institute of Nursing Research and by the American Academy of Hospice and Palliative Medicine, American Cancer Society, American Geriatrics Society, Anthem Inc., Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Arizona, Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of North Carolina, Bristol-Myers Squibb, The California State University Shiley Institute for Palliative Care, Cambia Health Solutions, Cedars-Sinai Health System, Center to Advance Palliative Care, Coalition to Transform Advanced Care, Excellus BlueCross BlueShield, Gordon and Betty Moore Foundation, The Greenwall Foundation, The John A. Hartford Foundation, Hospice & Palliative Nurses Association, Humana, Kaiser Permanente, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Palliative Care Research Center, National Patient Advocate Foundation, The New York Academy of Medicine, Oncology Nursing Society, Patient-Centered Outcomes Research Institute, Social Work Hospice & Palliative Care Network, Supportive Care Coalition, and the National Academy of Medicine.
International Standard Book Number-13: 978-0-309-67702-8
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Digital Object Identifier: https://doi.org/10.17226/25789
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Building the workforce we need to care for people with serious illness: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25789.
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PLANNING COMMITTEE FOR BUILDING THE WORKFORCE WE NEED TO CARE FOR PEOPLE WITH SERIOUS ILLNESS: A WORKSHOP1
BRYNN BOWMAN (Co-Chair), Vice President for Education, Center to Advance Palliative Care
BRENDA NEVIDJON (Co-Chair), Chief Executive Officer, Oncology Nursing Society
JENNIFER BALLENTINE, Executive Director, The California State University Shiley Institute for Palliative Care
ROBERT A. BERGAMINI, Medical Director, Palliative Care Services, Mercy Clinic Children’s Cancer and Hematology, representing the Supportive Care Coalition
GRACE B. CAMPBELL, Assistant Professor, Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, representing the Association of Rehabilitation Nurses
CLESE ERIKSON, Deputy Director, Health Workforce Policy Research Center, The George Washington University
DENISE HESS, Executive Director, Supportive Care Coalition, representing the Association of Professional Chaplains
AMY MELNICK, Executive Director, National Coalition for Hospice and Palliative Care
JERI L. MILLER, Chief, Office of End-of-Life and Palliative Care Research, Senior Policy Analyst, National Institute of Nursing Research, National Institutes of Health
MIGUEL PANIAGUA, Medical Advisor, Solutions Design and Delivery, National Board of Medical Examiners, and Adjunct Professor of Medicine, Perelman School of Medicine, University of Pennsylvania
PHILIP A. PIZZO, Founding Director, Stanford Distinguished Careers Institute, Former Dean and David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology, Stanford School of Medicine
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
JOANNE REIFSNYDER, Executive Vice President, Clinical Operations, and Chief Nursing Officer, Genesis Healthcare, representing the Hospice and Palliative Nurses Association
JOE ROTELLA, Chief Medical Officer, CatalystHPM, American Academy of Hospice and Palliative Medicine
TRACY SCHROEPFER, Professor, School of Social Work, University of Wisconsin
JOSEPH W. SHEGA, Regional Medical Director, VITAS Hospice Care, representing the American Geriatrics Society
JOAN WEISS, Chief, Geriatrics and Allied Health Branch, Health Resources and Services Administration
Project Staff
LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness
KAITLYN FRIEDMAN, Research Associate
RUHAMA GARI, Senior Program Assistant (from October 2019 to February 2020)
SHARYL NASS, Senior Director, Board on Health Care Services, and Director, National Cancer Policy Forum
ANDREW M. POPE, Senior Director, Board on Health Sciences Policy
Consultant
JOE ALPER, Consulting Writer
ROUNDTABLE ON QUALITY CARE FOR PEOPLE WITH SERIOUS ILLNESS1
LEONARD D. SCHAEFFER (Chair), Judge Robert Maclay Widney Chair and Professor, University of Southern California
JAMES A. TULSKY (Vice Chair), Chair, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; Chief, Division of Palliative Medicine, Brigham and Women’s Hospital; Professor of Medicine and Co-Director, Center for Palliative Care, Harvard Medical School
KIRK ALLEN, President, Humana at Home, Humana
JENNIFER BALLENTINE, Executive Director, The California State University Shiley Institute for Palliative Care
ROBERT A. BERGAMINI, Medical Director, Palliative Care Services, Mercy Clinic Children’s Cancer and Hematology, representing the Supportive Care Coalition
LORI BISHOP, Vice President of Palliative and Advanced Care, National Hospice and Palliative Care Organization
PATRICIA A. BOMBA, Vice President and Medical Director, Excellus BlueCross BlueShield; Chair, MOLST Statewide Implementation Team; Chair, National Healthcare Decisions Day, New York States Coalition
GRACE B. CAMPBELL, Assistant Professor, Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, representing the Association of Rehabilitation Nurses
JANE CARMODY, Program Officer, The John A. Hartford Foundation
STEVE CLAUSER, Director, Healthcare Delivery and Disparities Research Program, Patient-Centered Outcomes Research Institute
DAVID J. DEBONO, Medical Director for Oncology, Anthem Inc.
CHRISTOPHER M. DEZII, Lead, Quality and Measure Development, State and Federal Payment Agencies, U.S. Value, Access and Payment, Bristol-Myers Squibb
ANDREW DREYFUS, President and Chief Executive Officer, Blue Cross Blue Shield of Massachusetts
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
CAROLE REDDING FLAMM, Executive Medical Director, Blue Cross Blue Shield Association
MARK B. GANZ, President and Chief Executive Officer, Cambia Health Solutions
DENISE HESS, Executive Director, Supportive Care Coalition, representing the Association of Professional Chaplains
PAMELA S. HINDS, Director and Professor, Conway Chair in Nursing Research; Director, Nursing Research and Quality Outcomes, Children’s National Health System
HAIDEN HUSKAMP, 30th Anniversary Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School
KIMBERLY SHERELL JOHNSON, Associate Professor of Medicine, Senior Fellow in the Center of Aging and Human Development, Duke University School of Medicine
REBECCA A. KIRCH, Executive Vice President of Healthcare Quality and Value, National Patient Advocate Foundation
TOM KOUTSOUMPAS, Cofounder, Coalition to Transform Advanced Care; President and Chief Executive Officer, National Partnership for Hospice Innovation
SHARI M. LING, Deputy Chief Medical Officer, Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services
BERNARD LO, President and Chief Executive Officer, The Greenwall Foundation
DIANE E. MEIER, Director, Center to Advance Palliative Care; Gaisman Professor of Medical Ethics, Vice Chair for the Public Policy and Professor, Icahn School of Medicine at Mount Sinai
AMY MELNICK, Executive Director, National Coalition for Hospice and Palliative Care
JERI L. MILLER, Chief, Office of End-of-Life and Palliative Care Research, Senior Policy Analyst, National Institute of Nursing Research, National Institutes of Health
R. SEAN MORRISON, Co-Director, Patty and Jay Baker National Palliative Care Center; Director, National Palliative Care Research Center; Director, Hertzberg Palliative Care Institute; Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
BRENDA NEVIDJON, Chief Executive Officer, Oncology Nursing Society
JUDITH R. PERES, Long-Term and Palliative Care Consultant, Clinical Social Worker and Board Member, Social Work Hospice and Palliative Care Network
PHILIP A. PIZZO, Founding Director, Stanford Distinguished Careers Institute, Former Dean and David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology, Stanford School of Medicine
THOMAS M. PRISELAC, President and Chief Executive Officer, Cedars-Sinai Health System
KITTY PURINGTON, Senior Program Director, National Academy for State Health Policy
RUBINA RAJA, Medical Director Operations, Blue Cross Blue Shield of Arizona
RAHUL RAJKUMAR, Senior Vice President and Chief Medical Officer, Blue Cross Blue Shield of North Carolina
JOANNE REIFSNYDER, Executive Vice President, Clinical Operations, and Chief Nursing Officer, Genesis Healthcare, representing the Hospice and Palliative Nurses Association
JOE ROTELLA, Chief Medical Officer, CatalystHPM, American Academy of Hospice and Palliative Medicine
JUDITH A. SALERNO, President, The New York Academy of Medicine, Senior Vice President, Patient and Caregiver Support, American Cancer Society
JOSEPH W. SHEGA, Regional Medical Director, VITAS Hospice Care, representing the American Geriatrics Society
SUSAN ELIZABETH WANG, Regional Lead for Shared Decision-Making and Advance Care Planning, Southern California Permanente Medical Group, Kaiser Permanente
DAWN WIATREK, Director, Public Health Strategy, American Cancer Society
BALIGH YEHIA, Chief Medical Officer, Ascension Health
Roundtable on Quality Care for People with Serious Illness Staff
LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness
KAITLYN FRIEDMAN, Research Associate
RUHAMA GARI, Senior Program Assistant (from October 2019 to February 2020)
ANESIA WILKS, Senior Program Assistant (as of March 2020)
MICAH WINOGRAD, Senior Financial Business Partner
SHARYL NASS, Senior Director, Board on Health Care Services, and Director, National Cancer Policy Forum
ANDREW M. POPE, Senior Director, Board on Health Sciences Policy
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by MARK LAZENBY, Yale School of Nursing. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Acknowledgments
The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Quality Care for People with Serious Illness wishes to express its sincere gratitude to the Planning Committee Co-Chairs Brynn Bowman and Brenda Nevidjon for their valuable contributions to the development and organization of this workshop. The roundtable also wishes to thank all of the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. Finally, the roundtable wants to thank the speakers and moderators, who generously shared their expertise and their time with workshop participants.
Support from the many annual sponsors of the roundtable is critical to its work. The sponsors include the American Academy of Hospice and Palliative Medicine, American Cancer Society, American Geriatrics Society, Anthem Inc., Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Arizona, Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of North Carolina, Bristol-Myers Squibb, The California State University Shiley Institute for Palliative Care, Cambia Health Solutions, Cedars-Sinai Health System, Center to Advance Palliative Care, Coalition to Transform Advanced Care, Excellus BlueCross BlueShield, Gordon and Betty Moore Foundation, The Greenwall Foundation, The John A. Hartford Foundation, Hospice & Palliative Nurses Association, Humana, Kaiser Permanente, National Coalition for Hospice and Pal-
liative Care, National Hospice and Palliative Care Organization, National Institute of Nursing Research, National Palliative Care Research Center, National Patient Advocate Foundation, The New York Academy of Medicine, Oncology Nursing Society, Patient-Centered Outcomes Research Institute, Social Work Hospice & Palliative Care Network, Supportive Care Coalition, and the National Academy of Medicine.
Contents
OVERVIEW OF THE CURRENT STATE OF THE WORKFORCE FOR SERIOUS ILLNESS CARE AND FUTURE NEEDS
DEVELOPING THE WORKFORCE TO SPECIALIZE IN CARE FOR PEOPLE WITH SERIOUS ILLNESS
Projections for the Palliative Care Specialty Workforce
University-Based Certificate Programs
Interprofessional Palliative Education and Its Integration into Undergraduate Curricula
PREPARING ALL HEALTH PROFESSIONALS TO CARE FOR PEOPLE WITH SERIOUS ILLNESS
ELNEC: 20 Years of Providing Palliative Care Education
Equipping Mid-Career Clinicians with Core Skills for Serious Illness Care
The Role of an Accrediting Organization
DEVELOPING THE WORKFORCE FOR COMMUNITY-BASED CARE
The Current and Projected Workforce for Community-Based Care
Maximizing the Role of the Home Care Worker
Advancing a Well-Trained Workforce to Care for an Aging America
Innovations in Community-Based Care
USING INTERPROFESSIONAL TEAMS EFFECTIVELY TO CARE FOR PEOPLE WITH SERIOUS ILLNESS
Creating and Sustaining a Culture of Palliative Care in Long-Term Care Settings
Caring for the Seriously Ill Child at Home
Reaching Rural Areas Through Technology
Boxes, Figures, and Tables
BOXES
FIGURES
1 Funneled approach to palliative care delivery in patients with serious illness
2 Projected numbers of certified specialty palliative care physicians, 2018–2058
4 Number of people employed in jobs that are involved in community-based care
5 The community-based health care workforce is economically vulnerable
6 The 16 domains in which to engage individuals in bedside care planning
Acronyms and Abbreviations
AACN | American Association of Colleges of Nursing |
ACGME | Accreditation Council for Graduate Medical Education |
AHA | American Hospital Association |
APRN | advanced practice registered nurse |
BLS | Bureau of Labor Statistics |
CAPC | Center to Advance Palliative Care |
CEO | chief executive officer |
CMS | Centers for Medicare & Medicaid Services |
CSU | California State University |
ELNEC | End-of-Life Nursing Education Consortium |
GACA | Geriatrics Academic Career Award |
GWEP | Geriatric Workforce Enhancement Program |
HHS | Department of Health and Human Services |
HRSA | Health Resources and Services Administration |
iCOPE | Interdisciplinary Curriculum for Oncology Palliative Education |
IOM | Institute of Medicine |
iPEX | InterProfessional Education eXchange program |
NCHWA | National Center for Health Workforce Analysis |
NCI | National Cancer Institute |
NCP | National Consensus Project |
NP | nurse practitioner |
PA | physician assistant |
PCHETA | Palliative Care and Hospice Education and Training Act |
RN | registered nurse |
UCSF | University of California, San Francisco |
VA | Department of Veterans Affairs |