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Proceedings of a Workshop
Pages 1-96

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From page 1...
... The pandemic also offers opportunities to apply important lessons learned to improve care. In an effort to explore the impact of the pandemic on caring for people with serious illness, the National Academy of Sciences, Engineering, and Medicine's Roundtable on Quality Care for People with Serious Illness hosted a three-part virtual public workshop, Caring for People with Serious Illness During the COVID-19 Pandemic: A Workshop on Lessons Learned and Future Directions.
From page 2...
... The third webinar examined the issue of communicating with the public about health emergencies, with a particular eye to specific populations, such as pediatrics and minority populations. The final session explored the lessons learned from the perspective of policy opportunities to improve care for people with serious illness.
From page 3...
... • Establish relationships and collaborative partnerships between palliative care teams and other departments, such as the ICU and ED; preexisting relationships were critical to the success of innovative programs launched during the pandemic. (Ankuda, Cohen)
From page 4...
... • Consider adding cultural suffering as a fifth domain to the four domains of suffering that the palliative care field addresses. (Kangovi, Tucker)
From page 5...
... (Strand) • Support all members of the health care team through a range of strategies, such as flexibility in scheduling, com passionate leave policy, team debriefings and check-ins, and tools such as Code Lavender and the Circle Up frame work.
From page 6...
... Inequities and the Social Determinants of Health • Remember that the inequity story is the pandemic story, given that individuals from historically underserved commu nities shouldered much more of the brunt of the COVID-19 pandemic. (Boulware, Webb Hooper)
From page 7...
... It is a complicated cognitive, behavioral, and emotional construct, and once it has been lost, it is difficult to regain. (Webb Hooper)
From page 8...
... • Help the rural health care workforce develop palliative care skills to meet the needs of rural communities. (Justis)
From page 9...
... Perhaps most importantly, accept that attitudinal change and building trust take time. (Webb Hooper)
From page 10...
... WEBINAR ONE James Tulsky, of Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, and co-Chair of the Roundtable, opened the first webinar by noting that the world turned upside down in the spring of 2020, and for those who work in palliative care or other serious illness care, it was a time of great need, reflection, and value. "All of the things that we had been working on for so long suddenly were in the minds of everyone -- the role of family and social isolation, the need for high-quality decision making in the face of serious illness, the attention to symptoms and comfort in the face of illness that may be incurable, and the importance of high-quality communication in every facet of what we do," observed Tulsky.
From page 11...
... As a final note, Tulsky remarked that he is grateful that the broader health care workforce now values and appreciates the work of the palliative care team, but he wished it had not taken a pandemic to make that happen. In her overview of the workshop series, Planning Committee CoChair Susan Elizabeth Wang, National Lead, Palliative Care for Kaiser Permanente, said that in addition to the more than 750,000 Americans who died from the SAR-CoV-2 virus,3 up to one-quarter of those affected have sought care for "long COVID" symptoms4 that include memory loss, breathlessness, and fatigue.
From page 12...
... That infrequent nature tends to encourage overconfidence in terms of understanding, anticipation, and the ability to respond. In addition, Fineberg pointed out that the long interval between recent pandemics promoted neglect of the public health infrastructure that is so crucial to pandemic response.
From page 13...
... Fineberg identified the fourth key element as a sound pandemic response strategy. Good leadership that relies on science and has the public's trust has to translate those assets into a strategic response that encompasses ways to care for those who are ill, interrupts the speed at which an illness spreads, and puts in place the conditions that will minimize the consequences over time.
From page 14...
... Fineberg identified five consequences of not having those six elements in place during the COVID-19 pandemic: • the substantial number of patients experiencing the acute and long term consequences of infection; • the disruption in care affecting patients who had existing serious illnesses and the adaptation required to manage the care of all patients during the pandemic; • the stress on health care providers, health care institutions, and the health care system and the strain for continuous obligation and uncertainty; • the disparities in care that the pandemic has exacerbated and revealed as a severe deficiency in the nation's health care system; and • the disruption of the larger social context, economic system, and capacity to provide necessary social services and support systems for families and the ability of communities to function, all of which complicate the ability of the health care system and health professionals to provide the care that patients need. Together, these make the workshop discussions so important for taking stock of lessons from the pandemic, concluded Fineberg.
From page 15...
... "I do not think he quite understood it that first day, but over time, I think he grew to understand we were committed to his health." Slowly, the nursing facility was able to transition to a virtual platform for providing care, but in the interim, families were waiting anxiously to receive updated information about their loved ones. Families also had to participate in care planning and life-and-death decisions via telephone, even in instances where COVID-19 was not the primary concern.
From page 16...
... Carrol explained that the "N" in "change" was particularly important to him on a personal level, because it calls out the importance of nurturing the health care team. He recounted how, as the pandemic continued, and he and his colleagues focused on caring for their patients, they often neglected caring for themselves.
From page 17...
... Brynn Bowman observed that there was a rapid evolution and a great deal of creativity around how to best use telehealth to extend the scarce resources that many palliative care teams deal with regularly. For example, palliative care specialists were able to use virtual platforms to talk to patients in the emergency department (ED)
From page 18...
... "Fee-for-service is poorly matched to the needs of patients who have medical illness and complex needs over time," observed Bowman. Bowman explained that fee-for-service health care makes it difficult to collaborate with social workers or community service agencies to address the social determinants of health that Carrol discussed.
From page 19...
... "It highlights the importance of having a medical home and of having a medical director that is truly connected to the patients and their families, because if we get that buy-in, they will model our behavior," said Carrol. Salerno then asked Bowman to talk about how palliative care teams functioned when they had to talk to patients and families about goals of care in such a profoundly disjointed manner.
From page 20...
... "That makes sense because palliative care teams are expert at acting in an environment of uncertainty to relieve suffering and help patients cope and help support patients and families through complicated decision making," remarked Bowman. Salerno wondered if the principles of palliative care could help address the needs of patients dealing with long COVID.
From page 21...
... As a result, patients served by those organizations did not have the benefit of those services, nor were the treating clinicians able to lean on their palliative care colleagues. "We have to think about what that variability in access and preparedness means coming out of COVID-19," she said.
From page 22...
... The institution also collaborated with colleagues in New York City to provide additional telehealth training for adult and pediatric palliative care at the height of the pandemic. • Hannah Coyne and Patrick Coyne, from the Medical University of South Carolina, discussed Code Lavender, a program they used to provide peer support for team members.8 It included a virtual debriefing where staff members could speak with chaplains, therapists, and the bereavement coordinator about their experiences.
From page 23...
... She also learned that improbable does not mean impossible when the team comes together to support a vision and that, in chaos, it is important to keep or establish a routine and structure that can provide comfort in the storm. 9 See https://www.heartofhospice.net (accessed March 10, 2022)
From page 24...
... . The two palliative care specialists built this service, known as "PATCH-24," to prevent calls to their overwhelmed clinicians from going to voicemail and ensure that no one would have to wait more than 30 seconds to reach a trained palliative care clinician.
From page 25...
... They helped coach other clinicians to understand when it was appropriate to use the call line, while also building familiarity with palliative care. Ankuda acknowledged that this staffing model was not sustainable, even for a health system such as hers that has a substantial palliative care service.
From page 26...
... For example, two of the health system's hospitals had a large number of residents who were looking for a role. "We were able to work with our social workers to create a training module where they all learned about New York State's surrogate decision-making laws, which are a bit complex, and also learned how to have conversations with patients about health care proxies," said Ankuda.
From page 27...
... PATCH-24 relied heavily on physicians because they were available; chaplains and social workers were consumed with their expanded roles on the palliative care consult teams embedded in ICUs. Ankuda believes that incorporating the full interdisciplinary team in such programs would be extremely useful, particularly if patients and families were screened in advance to identify who would benefit most from interdisciplinary team care.
From page 28...
... Given this looming crisis, continuing to partner across disciplines will become even more important. Bellevue and NYC Health + Hospitals' Response to the Patient Surge To put her institution's experience during the pandemic's early days in context, Susan Cohen, medical director of the palliative care program at NYC Health + Hospitals/Bellevue, noted that Bellevue is the nation's oldest public hospital.
From page 29...
... Despite the limited supply of palliative care clinicians, coverage increased to 7 days a week for 5–6 weeks. Palliative care team members' roles included providing medical updates to family members, supporting care teams through ethical issues, and engaging in care planning and discussions of patient goals and values.
From page 30...
... The combination of loss of health insurance and economic instability meant that many Black/African American and Hispanic/Latinx individuals were 1.5- to 2-fold more likely to delay or avoid urgent or emergency care compared to white individuals. Those delays, said Boulware, often resulted in negative health consequences.14 In 14 See https://www.rwjf.org/en/library/research/2020/09/the-impact-of-coronavirus on-households-across-america.html#:~:text=While%20billions%20of%20dollars%20 have,not%20been%20protected%20from%20serious (accessed March 15, 2022)
From page 31...
... Ebony Boulware, November 8, 2021; content adapted from CDC, 2021. Data Visualization.
From page 32...
... Boulware pointed to the increased use of alternative methods of connection, primarily telehealth, as one bright spot during the pandemic. She noted that one study found that Black/African American and Hispanic/ Latinx individuals were more likely to report using telehealth to connect with physicians or other medical professionals (Campos-Castillo and Anthony, 2021)
From page 33...
... They need to come from across multiple sectors of society to address these inequities," Boulware concluded. Discussion Session Lori Bishop, vice president of palliative and advanced care at the National Hospice and Palliative Care Organization, and Karen Bullock, professor and John A
From page 34...
... Ankuda agreed that preexisting relationships with EDs made it much easier to introduce PATCH-24 than with EDs that had not previously bought into palliative care. She noted that a colleague conducted an informal survey of ED physicians at the end of 2019 to see if they thought palliative care was part of their job, and the majority said no.
From page 35...
... As much as the health care system needs to address clinician wellness issues, Ankuda suggested that it also needs to address staff's struggles with paperwork, electronic health records, and other bureaucratic responsibilities that have increased over the years. She also noted the gender inequalities that the pandemic highlighted in terms of caregiving responsibilities and hoped that health system leadership would address this issue.
From page 36...
... Cohen shared that her palliative care team realized that the ICU was filled with Hispanic/Latino men whose family members were actually in the same ICU. The families were traumatized, and members of her team were stunned by the multiple losses families were experiencing.
From page 37...
... The key themes that Wang took away from the first session's presentations included Fineberg's discussions of how leadership, science, public trust, preparedness, and strategic response are required for recovery and Carrol's acronym for change as a constant. The first session highlighted key issues, including the value of team-based care, the need for interprofessional training, the critical role of palliative care as a specialty as well as a skill set for all clinicians, and how virtual platforms helped provide patient-centered care.
From page 38...
... During the pandemic, many health systems nationwide were able to use telehealth to extend the reach of a scarce resource, their palliative care teams. Technology also enabled families to connect with loved ones, and the capacity to make those connections helped relieve some of the moral distress that the battered health care workforce was experiencing.
From page 39...
... PROCEEDINGS OF A WORKSHOP 39 FIGURE 6 An illustration of the emotional trajectory many individuals experienced during the COVID-19 pandemic. SOURCE: As presented by Rodney Tucker, November 18, 2021; adapted from Dewolfe, 2000.
From page 40...
... be flexible in terms of scheduling and being able to help one another; (2) take advantage of the power of the debrief, which is something practiced in palliative care; and (3)
From page 41...
... . Larson referred to a 2020 survey that found that 22 percent of nurses surveyed indicated they may leave their current positions, and 60 percent 16 See https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage (accessed March 10, 2022)
From page 42...
... In closing, Larson offered four ways to support the nursing workforce: 17 See https://www.trustedhealth.com/the-handoff-podcast/joanne-spetz (accessed March 10, 2022)
From page 43...
... • Reimagine delivery models and improve organizational climate by leveraging digital tools, adapting care models based on patient and employee preferences, supporting leadership training programs and mentorships, and building learning networks and coalitions across agencies and systems of care. • Strengthen talent pipelines and build skills for the future by implementing national training requirements for frontline staff based on core competency standards, supporting reskilling when needed, and bolstering recruitment pipelines for clinical roles.
From page 44...
... 19 A detailed tool is available at http://www.ihi.org/resources/Pages/Tools/SBARToolkit. aspx (accessed March 10, 2022)
From page 45...
... among health care professionals. 21 See https://www.theschwartzcenter.org/programs/schwartz-rounds (accessed March 10, 2022)
From page 46...
... The Role of Community Health Workers in the Pandemic Shreya Kangovi, founder and executive director of the Penn Center for Community Health Workers and associate professor at the Perelman School of Medicine, opened her remarks by reinforcing what previous speakers had highlighted: the pandemic has had a disproportionate impact on people of color and people living in rural areas. "These are the people in our hardest-hit communities in America who have been seriously ill, who have been dying at startling rates, not only of COVID and its effects, including deferred preventive care and mental health challenges, but also due to long-standing issues such as food insecurity, police violence, and disparities of every kind," she explained.
From page 47...
... "By definition, if we transfer power to community health workers, we are 22 See https://www.nachc.org/wp-content/uploads/2020/01/Chartbook-2020-Final.pdf (accessed March 10, 2022)
From page 48...
... At Penn Medicine, Kangovi explained, the chief executive officer and other senior executives now have CHW mentors who train them on what it is like to live with some of these inequities (Vasan et al., 2021)
From page 49...
... Kangovi explained that her center has been pushing for broader Medicaid coverage of CHW services and ensuring that funding is aligned with quality standards. "This will ensure that the work is high quality and that community health workers are not co-opted or over medicalized," Kangovi explained.
From page 50...
... She explained that her program pairs 25 Palliative care addresses physical, psychological, social, and spiritual aspects of care. See https://www.nationalcoalitionhpc.org/ncp (accessed March 15, 2022)
From page 51...
... Lessons from the Patient-Centered Outcomes Research Institute's Investment in Telehealth Research Steven Clauser, program director for health care delivery and disparities research at the Patient-Centered Outcomes Research Institute (PCORI) , opened his remarks by noting that at the time of the webinar, telehealth
From page 52...
... PCORI funded 24 studies intended specifically to address the challenges of delivering care virtually during the pandemic. Nineteen of 26 See https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Physician FeeSched (accessed March 15, 2022)
From page 53...
... (Some studies focused on more than one subject.) Clauser discussed a study that compares the impact of two different models of palliative care -- one that moves largely to care provided virtually and another that maintains in-person visits -- to determine whether they provide similar outcomes to patients (Chua et al., 2019)
From page 54...
... He also explained that the palliative care program he runs has a large in-hospital consult service, an outpatient referral practice, embedded oncology clinics, primary palliative care inpatient service, and a regional hospice for approximately 200 patients under Mayo Clinic's care in southeast Minnesota. Strand works with other leaders to coordinate and standardize palliative care interventions across Mayo Clinic's various care settings.
From page 55...
... To illustrate these differing opinions about the role of telehealth in serious illness care, Strand recalled a patient with advanced lung cancer who did not want to come to the clinic to see her oncologist or the palliative care team managing her cancer-related pain. She called when she noted some acute symptom changes, and the initial reaction of some of the outpatient palliative care team was that they could not do virtual care and wanted her to come to the ED.
From page 56...
... Using Telehealth to Provide Palliative Care to People in Rural Areas Pat Justis, executive director for rural health in the Washington State Department of Health, was the final presenter. Justis explained that 96.4 percent of the state of Washington is rural, with some counties that are designated as frontier areas,28 which are among the most remote and least populated areas in the nation.
From page 57...
... The hypothesis was that if her team used case consultation via telehealth, it could also provide secondary palliative care for more complex cases. The team could consult with a tertiary expert team for more complex cases.
From page 58...
... Justis pointed out that the pandemic helped the 13 pilot sites jump faster from planning to testing and implementation of telemedicine palliative care visits. Rural health organizations are proceeding with expanded telemedicine as a prime mode for palliative care, and her office will continue providing the expert panel to guide and train rural health teams.
From page 59...
... Similarly, clinicians have reported missing the ability to engage with a colleague down the hall or bring a social worker or chaplain into a visit. As a result, his team is working to build out some of its care models to allow clinicians to bring in colleagues when needed to augment a visit.
From page 60...
... Justis said that helping the rural health care workforce develop palliative care skills is critical to meet the needs of rural communities. However, that workforce needs to recognize its limits in terms of determining which patients' needs they can handle and whom they need to refer to palliative care specialists.
From page 61...
... Public Health Communication and Research Translation The third and final webinar took on two main topics. The first session focused the challenge of public health communications during the pandemic in general and for specific populations, such as pediatric patients and racial and ethnic minority groups.
From page 62...
... Jha explained that in a health crisis, ordinary people must do extraordinary things. "These are extraordinary moments where we have asked people to fundamentally alter the way they live their lives, the way they see their loved ones, the way they engage in their work, and the way they engage with school," said Jha.
From page 63...
... "That, by the way, is a truism throughout all of history," said Jha. "That is not a phenomenon of the COVID-19 pandemic or the twenty-first century." Pointing to the echo chambers in which everyone lives as an example of a twenty-first-century phenomenon, Jha explained the way information is disseminated creates self-perpetuating, self-enforcing information echo chambers where one bad idea can take hold, get amplified by multiple actors, and then become "gospel truth," explained Jha.
From page 64...
... Jha shared that when he was trained as a scientist to write or talk about his work, for example, he learned to discuss the limitations of his research, uncertainty in the findings, and exceptions that might make his findings null or not fully applicable. "This is how science works, and it is a good thing for the scientific process," said Jha, "but it does not work well in public communication." Jha pointed out that the expert community has not done an adequate job of communicating to the U.S.
From page 65...
... We are asking people to do things they would never do before under normal circumstances, and that fundamentally requires trust," concluded Jha. Discussion Session Pamela Hinds, executive director in the department of nursing science and research integrity officer at the Children's National Hospital and professor of pediatrics in the School of Medicine and Health Sciences at George Washington University, asked Jha to comment on a situation in which he regrets a personal decision related to teaching the public about science.
From page 66...
... Hinds then asked Jha if his approach to science communication changes when dealing with those who are involved with misinformation or disinformation. Jha replied that the first step is to understand what motivates people to create and spread misinformation or disinformation, and those motives differ.
From page 67...
... The patient's wife told Lamas that she had been reading and wondered if her husband could get convalescent plasma. Lamas took out her patient list, wrote "palliative care" next to his name, and told his wife that the palliative care team would be around later to help her navigate what was to come.
From page 68...
... Before the pandemic, the ICU was a place where families observed procedures and sometimes even resuscitation attempts, in large part because staff had come to recognize that families were not just visitors but essential members of the care team. But once the pandemic hit, family members were gone, Lamas explained.
From page 69...
... "But that was not its only impact," she continued, "for it also broke down the divide between our patients and ourselves, forcing us to realize that anyone at any time could become seriously ill, and forcing us to see the extent to which we are all truly interconnected." Lamas concluded that her hope is that the health care community will take all the critical lessons learned during the pandemic and use them to improve care.
From page 70...
... . DeBiasi described how she realized early on that she and her colleagues had to educate the public about their experience with pediatric patients, to encourage parents to look for the signs of severe illness and prepare hospitals for the potential influx of pediatric patients with unique needs.
From page 71...
... %2C%20also,reported%20in%20Hawaii%20in%201976 (accessed March 8, 2022)
From page 72...
... DeBiasi also noted that loss of learning is a particular problem among Black and Brown students who have been affected disproportionately by the move to virtual instruction during the pandemic. National Institutes of Health's Efforts to Reduce COVID-19 Health Disparities and Distrust Monica Webb Hooper, deputy director of the National Institutes of Health (NIH)
From page 73...
... Webb Hooper observed that early in the pandemic, scientists, physicians, and health officials often noted medical comorbidities as the cause of disparities, and racial and ethnic minority populations have a disproportionate burden of underlying comorbidities. Webb Hooper emphasized, "Race is a sociocultural construct, not a biological or genetic one, and race is important to study because it shapes the lived experiences of all groups.
From page 74...
... Above all, Webb Hooper said, simply asking people to join a study is an effective strategy. As CEAL was beginning its work, NIH leadership worked closely with Moderna on its COVID-19 vaccine trial to focus on increasing enrollees' 34 See https://covid19community.nih.gov (accessed March 15, 2022)
From page 75...
... Webb Hooper replied that because the pandemic 35 See https://www.nhlbi.nih.gov/news/2021/researchers-take-cues-past-ensure-diversity covid-19-clinical-trials (accessed March 15, 2022)
From page 76...
... Webb Hooper added that trust is an underappreciated social determinant of health. Trust, she said, is a complicated cognitive, behavioral, and emotional construct, and once damaged or broken, it is hard to win back.
From page 77...
... "This was an interesting moment of how do you build trust with people, and what does it mean if building trust means doing something that you do not actually think is useful for your patient," said Lamas. Webb Hooper commented that the early assumption that educating the public would be sufficient for building trust turned out in hindsight not to be the best approach, particularly since information has been changing so rapidly during the pandemic.
From page 78...
... Another audience member asked the panel to comment on ethnic and racial underrepresentation in international clinical trials. Webb Hooper responded that one reason is that the distribution of race and ethnicity and even the concerns about it are different in many countries.
From page 79...
... refresh strategy as an accelerator for value-based payment models for serious illness care? • How do we ensure health equity as part of the future of care models and payment models?
From page 80...
... "To achieve our accountable care goals, we know that we have to 37 See https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation (accessed March 15, 2022)
From page 81...
... "If we want to reach our goals for accountable care and advancing health equity, we are going to need to understand and address the barriers so that more folks can cross that threshold into value-based payment and then be able to sustain their participation once they are in," said Rawal. At the first of a long-term series of listening sessions her team held (a general session)
From page 82...
... "We want to define our success more broadly and think more deliberately on the front end about the potential for models to have these provider and system impacts," said Rawal in closing. Investing in Quality, Workforce, and Payment Models for Care of People with Serious Illness Joe Rotella, chief medical officer of the American Academy of Hospice and Palliative Medicine (AAHPM)
From page 83...
... Hospice has remained the gold standard for end-of-life care, care quality, and, when used appropriately, cost control. The Affordable Care Act of 2010 established CMMI, which in 2014 granted a health care innovation award to Four Seasons Compassion for Life and Duke Medical Center for its demonstration of community-based palliative care.39 Rotella explained that another important step toward value in serious illness care was the Medicare Access and CHIP Reauthorization Act of 2015 38 See http://aahpm.org/uploads/advocacy/The_Evidence_for_High-Quality_Palliative _Care.pdf (accessed March 10, 2022)
From page 84...
... It is now ending and has proven to be one of the more successful models.42 In 2018, CMS awarded MACRA funding to AAHPM and its partners, the RAND Corporation and the National Coalition for Hospice and Palliative Care, to develop palliative care quality measures to use in the quality payment program. CMMI announced several models affecting people with serious illness, including the value-based, insurance-designed hospice carvein option in 2021.43 CMMI also announced its new strategic direction, as Rawal discussed, placed the geographic direct contracting model on hold, and decided not to go forward with a serious illness population model.
From page 85...
... In keeping with CMMI's new strategy, this project involved patients on the technical panel and included vigorous public engagement from over 200 stakeholders during the comment period.48 Rotella noted that the National Coalition for Hospice and Palliative Care has submitted recommendations to CMMI,49 including the following key points: 44 See https://www.cms.gov/Medicare/Quality-Payment-Program/Quality-PaymentProgram (accessed March 10, 2022)
From page 86...
... There is a need to study and leverage telehealth as a means of improving access to palliative care and an imperative to address systemic causes of burnout, moral distress, and inequity. In closing, Rotella said that the Triple Aim needs to become the Quintuple Aim -- better outcomes, better experiences, and lower costs sustained by thriving clinicians who deliver more equitable care.
From page 87...
... The community palliative care model is an example of a care rather than a payment model. Gilfillan suggested thinking about how to conduct an integrated test for a model that provides care for the serious illness population, such as a team-based, community-based care model in the context of affordable care organizations.
From page 88...
... He also supported the idea that this test should be about quality of care, not cost, because it will include investments in elements outside of traditional fee-for-service health care that are essential to palliative care but currently unfunded. In addition, palliative care exists not to control costs but to give each person with serious illness the best quality of life they can have, which can sometimes, but not always, save money.
From page 89...
... Broyles noted that the number of Medicare Advantage plans with a palliative care benefit more than doubled from 2020 to 2021. Turning to the subject of equity, Broyles asked Rawal how she views social determinants of health being addressed in CMMI's models.
From page 90...
... He added that it is necessary to identify the social determinants before addressing them, which requires starting with a comprehensive assessment that views people as not just health entities, but as human beings who have social lives, practical problems, and financial issues. Rotella emphasized that this is the basis of the comprehensive palliative care assessment that serves as the foundation of developing a care plan to address what matters to the individual.
From page 91...
... "We need to continue to systematically scale up what was working before the pandemic, particularly expanded access to palliative care in all settings, while integrating the best of palliative care innovations and adaptations from COVID across all care delivery and all care delivery models for patients with serious illness," she said.
From page 92...
... "The benefit of a holistic approach addressing quality of life and supporting families is obvious," concluded Wang, "so the compelling theme of this workshop for me is that a palliative care perspective offers solutions for our entire health system." REFERENCES AACN (American Association of Colleges of Nursing)
From page 93...
... 2015. Measuring what matters: Top-ranked quality indicators for hospice and palliative care from the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association.
From page 94...
... 2020. Evidence-based community health worker program addresses unmet social needs and generates positive return on investment.
From page 95...
... . www.isu.edu/~bhstamm or www.proqol.org (accessed March 20, 2022)


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