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Choosing a Model

Choosing a Model. Charles F. von Gunten, MD. Center to Advance Palliative Care Mount Sinai School of Medicine 1255 5th Avenue, C-2 New York, NY 10029 212-201-2670 office 212-426-1369 fax 212-201-2680 event line www.capcmssm.org.

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Choosing a Model

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  1. Choosing a Model Charles F. von Gunten, MD

  2. Center to Advance Palliative Care Mount Sinai School of Medicine 1255 5th Avenue, C-2 New York, NY 10029 212-201-2670 office 212-426-1369 fax 212-201-2680 event line www.capcmssm.org A national initiative supported by The Robert Wood Johnson Foundation at the Mount Sinai School of Medicine.

  3. Palliative Care Hospice Therapies to modify disease Palliative Care Presentation 6m Death Therapies to relieve suffering and/orimprove quality of life BereavementCare

  4. Inpatient Unit Home care teams Consultation Services Hospital Ambulatory Home Care Teams Inpatient Units Consultation Services Hospital Ambulatory England vs USConvergent Evolution

  5. Palliative Care Inpatient Unit Consultation Home

  6. Elements Acute PalliativeCare Unit Home Hospice Hospital Consultation Ambulatory Outpatient Hospice Unit Home Health Nursing Home Residential Hospice Home

  7. Model Programs

  8. Mercy Health PartnersCincinnati, OH Home Hospice Hospital Consultation Home Health RN Consult

  9. Mercy Health PartnersCincinnati, OH • Came out of committee and an administrator with interest (loss)

  10. Carondolet Health CareTucson, AZ Hospital Education Home Hospice Hospice Unit

  11. Carondolet Health CareTucson, AZ • Hospice program desiring to go “upstream” • Focus groups describing need (Native American)

  12. Marshall HospitalSnowline Hospice, CA Hospital Consultation Home Hospice RuralPartnership RN, SW Consult

  13. Marshall HospitalSnowline Hospice, CA • Hospice desire for space in hospital • Case of a 2 yo child too ill to go home, hospice help in hospital

  14. Allina Health SystemMinneapolis, MN Home Hospice Hospital Consultation Ambulatory Outpatient Home Health MD Consult (inpt)RN Consult (outpt)

  15. Allina Health SystemMinneapolis, MN • Managed Care • Nurse approached MCO to negotiate outpatient visit coverage • Board of Directors listened to ethicist for inpatient consultation service

  16. Mt. Carmel SystemColumbus, OH Hospital Consultation Acute Palliative Care Units HomeHospice Home Health 3 Hospitals MD, RN Consults

  17. Mt. Carmel SystemColumbus, OH • Outreach of hospital-based hospice/home care agency led by one administrator

  18. Parkland HospitalDallas, TX Hospital Consultation Public Hospital >60% no insurance MD, RN, SW, Chaplain Team Ambulatory Outpatient

  19. Parkland HospitalDallas, TX • Physician with interest • Nurse administrator (hospice background) • Case management model

  20. How models chosen • Administrator interest • Clinician interest • Community pressure • Serendipity (loss) • Opportunity

  21. Advice • Be careful what you wish for…you might get it • Plan for growth

  22. Advice • It is better to beg forgiveness than to ask for permission

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