Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

Executive Summary of 2003 Circle of Life Award Winner

Providence Health System
End-of-Life Care Program
Adrienne Simmons
Regional Director of Planning/End-of-Life Care Program
1235 NE 47th Avenue, Suite 299
Portland, Oregon 97213
www.providence.org

Providence Health System in Portland, Oregon is a founding member of the Supportive Care of the Dying Coalition. Core values include respect, compassion, justice, excellence and stewardship. They attempt to provide end-of-life care that is patient and family-centered and consistent with these values, but face the same challenges as every health system in the US: money and staffing.

A comprehensive health care system, Providence aims for an integrated delivery system. In the Portland, Oregon metropolitan area, it includes two tertiary care hospitals, one community hospital, hospice, palliative care services, ambulatory care services, an HMO and a Program of All-inclusive Care of the Elderly (PACE) site called ElderPlace. This program offers services to frail elders who receive both Medicare and Medicaid and are eligible for nursing home residence and allows participating elders to continue residing in the community. Providence Health Plan was the first payer to reimburse for the Providence Palliative Care program which provides hospice-like pain and symptom management for patients who choose to continue active treatment of their life-threatening illness. Close collaboration between Providence’s delivery system and the Providence Health Plan HMO has been a major driver of some of these innovative programs.

Among the services they offer are: prescriptive harp music in two of its Portland hospitals, a Supportive Care Team, pre-printed physician orders for resuscitation and withdrawal of life support, an inpatient family satisfaction survey, and an outpatient palliative care service with nurse practitioners who provide assessments at patients’ homes. Advance care planning is emphasized. Completion of the Physician Orders for Life Sustaining Treatment (POLST), a physician order for emergency interventions that is honored by emergency medical personnel, is encouraged for people age 75 and older, and POLST preferences are documented.

Administrative commitment to end-of-life care is strong. End-of-life care is one of five clinical quality topics highlighted in Providence’s management objectives. A physician-led interdisciplinary Excellence in End-of-Life Steering Committee meets quarterly to share best practices, review proposed policies and other end-of-life activities, disseminate end-of-life measurement results, and initiate new end-of-life innovations or quality improvement projects. Daily and formal training opportunities are provided to staff across levels. Providence is known for the strength of its pastoral care departments. Chaplains are an integral part of inpatient and hospice staffs. Two Providence teams participated in an Institute for Healthcare Improvement (IHI) Breakthrough Series, "Advanced CHF and COPD." The program spotlighted in this issue of Innovations grew out of that initiative.

Providence’s end-of-life work extends to the community. Staff members facilitate several grief groups and hospice-trained volunteers lead sessions on a variety of topics to churches, civic organizations and businesses through the Providence Community Care program.

The entire Providence Health System spans a four-state area—Alaska, Washington, Oregon, and Southern California—and operates 20 acute care hospitals, 9 freestanding long-term care facilities, and 15 low-income and assisted living facilities. It is Portland, Oregon's Providence Health System End-of-Life Care Program that has been selected to receive a 2003 Circle of Life Award.

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