PROFESSIONMovement toward collaboration in clinical palliative careMore hospitals are developing programs for patients with serious illnesses.By Damon Adams, amednews staff. Aug. 20, 2001. Russell Portenoy, MD, and his department are at the forefront of palliative care. Dr. Portenoy's pain medicine and palliative care department at Beth Israel Medical Center in New York City was among the first departments of its kind. Today, it offers expert palliative care consultation, features a 14-bed inpatient unit and boasts eight physicians and more than 20 nurses.
The department, started in 1997, is an example of how palliative care is catching on. It is spotlighted in a new report, "Building Hospital Palliative Care Programs: Lessons from the Field," by the United Hospital Fund of New York. "There's clearly a palliative care movement happening in the country now," Dr. Portenoy said. "We have just now caught a wave." The report, released in July, details the experiences of Beth Israel and four other New York City hospitals that received $1.1 million in grants from the fund over two years to develop clinical palliative care services. The other four hospitals examined in the study were: Mount Sinai School of Medicine and Mount Sinai Hospital; Saint Vincent's Hospital and Medical Center of New York; Brooklyn Hospital Center; and Montefiore Medical Center. The report gives recommendations for developing palliative care programs in hospitals. Among them:
Palliative care is "moving into many hospitals. It's a field that's expanding very quickly," said the report's author, Susan Shampaine Hopper, PhD, project director of the fund's palliative care initiative. About 20% of hospitals have some sort of palliative care program, according to Dr. Portenoy. The American Board of Hospice and Palliative Medicine, formed in 1995, has certified 835 physicians worldwide in the specialty of hospice and palliative medicine. "That is a growing number," said Dale Ellen Lupu, PhD, president and CEO of the Maryland-based board, adding that more that half of those certified are internists. The National Hospice and Palliative Care Organization said the hospital fund's conclusions are consistent with the initial findings of a national study it is conducting with the Center to Advance Palliative Care at Mount Sinai. The study on hospice-hospital palliative care partnerships is due for release in September. "NHPCO applauds the local efforts outlined in 'Building Hospital Palliative Care Programs' because -- despite the challenges -- these local efforts seek to improve palliative and end-of-life care for hospitalized patients," said Stephen Connor, PhD, vice president for research and development for Virginia-based NHPCO. Palliative care pioneers are challenged to teach physicians and hospital staff about its potential contributions to a patient's quality of life, according to the study. "More and more communities are seeking to enhance palliative services, and hospice-hospital partnerships offer another effective way to deliver those services -- in the hospital or in the patient's home," Connor said. "There is no single model of palliative care, but hospice-hospital partnerships are demonstrating new and distinct advantages for completing the continuum of care for chronically and terminally ill patients." Hopper and others caution that palliative care services in hospitals are costly and demanding of staff and resources. But they say such care continues to be embraced by hospitals. "We really have some momentum," Dr. Portenoy said. ADDITIONAL INFORMATION:WeblinkExecutive summary, "Building Hospital Palliative Care Programs," United Hospital Fund of New York (http://www.uhfnyc.org/research/improve/copcireport.html) American Board of Hospice and Palliative Medicine (http://www.abhpm.org/) National Hospice and Palliative Care Organization (http://www.nhpco.org/) Copyright 2001 American Medical Association. All rights reserved.
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