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

Harry R. Horvitz Center for Palliative Medicine
Cleveland Clinic Foundation
Susan B. LeGrand, MD
Director, Palliative Medicine Fellowship Program
9500 Euclid Avenue, T40
Cleveland, OH 44195

Developed at the Cleveland Clinic Foundation in 1987 originally as a palliative medicine consultation service to improve the care of cancer patients, the Harry R. Horvitz Center began with one attending physician, one nurse and a part-time social worker. Over the next 11 years it grew into a Palliative Medicine Program (PMP) consisting of a 23-bed acute care palliative medicine unit and the first comprehensive program in the United States to provide clinical services, education, research and training in palliative care. Fellowship training began in 1989 and was the first available in the U.S. Second and third clinical fellowships were added in 1992 and 1998, respectively. The World Health Organization (WHO) designated the Palliative Medicine Program a national and international demonstration project in palliative care.

The Horvitz Center aims to provide patient-centered care for patients with life-threatening disease, and their families. Their mission includes advocating for patient dignity, comfort and choice, and providing bereavement counseling for patients and families throughout the course of life-threatening illness and for the surviving family members after the patient has died. They use dedicated palliative medicine nurse managers to facilitate continuity of care, and maintain a 24-hour hotline for patients and families.

Unique features at the Horvitz Center include the use of music therapy; providing the family with cots, recliners and showers for staying with the patient during his/her illness; and ensuring that the highest level of continuity of care is maintained. A focus on facilitating the best possible communication between patient, family and caregivers is created by making sure everyone involved understands the status of the disease process. Staff and families discuss expectations, preferences and goals for care.

Additionally, the Horvitz Center has become one of the strongholds of education and research in the field of Palliative Medicine. Ongoing education has been integrated into the daily functioning of the Horvitz Center. Physician education includes programs for medical students, residents, fellows, and Roxane Scholars; the center holds two major educational conferences per year; and the PMP offers training to numerous other healthcare professionals, including physician's assistants, nurses and chaplains.

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