The International Association for Hospice and Palliative Care (IAHPC) selection committees have chosen the following winners of the IAHPC 2006 Recognition Awards. For the first time in the history of this program, two programs were selected as winners of the Institutional Award. The committee felt that both programs deserved this recognition and decided to give a prize to each.
Programa de Cuidados Paliativos Gobierno de CataluZa (Palliative Care Program, Department of Health, Government of Catalonia), Barcelona, Spain. The Palliative Care Program of the government of Catalonia was selected as a winner of this year's award as an example of excellent palliative care integrated in public policy. The program was put in practice more than 10 years ago as a WHO demonstration project. The Catalonia WHO demonstration project for palliative care implementation was designed jointly by the Catalan Department of Health and the WHO cancer unit as a means to provide a systematic implementation process for all types of resources in the healthcare system. The basic aims were to achieve public coverage for cancer and non-cancer patients through accessibility, equity, and quality (effectiveness, efficiency), all of which could be used as references for other ministries of health to rationally plan palliative care. The project also included all of the elements of a systematic approach: needs assessment, implementation of specialized services, opioid availability, education and training, research, quality assessment, financing systems, legislation (1990) and standards (1992), and indicators to monitor progress. Additional information is available at http://www.hospicecare.com/Awards/2006inst.htm.
Pain and Palliative Care Unit-Children's Hospital at Westmead, Sydney, Australia. The Pain and Palliative Care Unit at Children's Hospital is under the leadership of Dr. John Collins. The committee selected this service as recognition of the care that the unit has provided to meet the needs of children with pain and advanced progressive conditions. The group provides comprehensive multidisciplinary pain and palliative care through inpatient and outpatient services. Additional information about the service is available at http://www.hospicecare.com/Awards/2006instb.htm.
In the Vittorio Ventafridda Award (Individual Category), Dr. Robert Twycross (UK) is the author of nearly 300 articles, chapters, and editorials on palliative medicine. Dr. Twycross received his medical training at Oxford and served as a fellow at London's renowned St. Christopher's Hospice starting in 1971. He has taught and promoted palliative care in more than 40 countries, led WHO's Collaborating Center for Palliative Care from 1988 to 2005, and was the Academic Director of the Oxford International Centre for Palliative Care. His bio and photo can be seen at http://www.hospicecare.com/Awards/2006indv.htm.
In the University Category, the American Association of Colleges of Nursing (AACN) (USA) won the award in recognition of the extraordinary work by the End of Life Nursing Education Consortium (ELNEC) developed in 1999. The AACN is the national voice for baccalaureate and higher degree nursing education programs in the United States. AACN advances nursing education, research, and practice by setting curriculum standards, building coalitions, supporting faculty and dean development, advocating for federal support, collecting data to shape public policy, and pursuing special educational projects in end-of-life/palliative care and geriatric nursing. AACN joined forces with the City of Hope National Medical Center to develop the ELNEC project. The ELNEC training program was developed as a 2.5-day train-the-trainer program with the intent that both undergraduate and graduate faculties would return to their universities to disseminate the information they had learned to their nursing students and other nursing faculty during future training courses. Additional information about the AACN and the ELNEC project is available at http://www.hospicecare.com/Awards/2006univ.htm.
The IAHPC congratulates the winners of these well-deserved awards for their outstanding efforts to improve palliative care around the world. Additional information about the IAHPC Recognition Awards Program and a list of past winners is available in at the IAHPC Web site at http://www.hospicecare.com/Awards/.
IAHPC also participated with a booth at the Annual Meeting of the American Academy of Hospice and Palliative Medicine (AAHPM) and HPNA in Salt Lake City, UT between February 14 and 17. This meeting has been growing in size during the past years and has become an important meeting for physicians, nurses, and palliative care workers in the US and increasingly from other countries. In addition to the booth staffed by Ana Restrepo, manager of IAHPC member services, Liliana De Lima participated in a panel on international palliative care initiatives chaired by Dr. Kathy Foley, with Dr. Frank Ferris, Medical Director of the Center for Palliative studies at San Diego Hospice, CA, and Mr. David Joranson, Director of the Pain and Policy Studies Group at the University of Wisconsin in Madison, WI. For more information and news, visit IAHPC's Web site at http://www.hospicecare.com.
OralFlo Cup Helps Patients Avoid Crushing Pills
Recent warnings have been issued to consumers by healthcare groups about crushing pills to make them easier to swallow, which can cause serious side effects that could be fatal. Pills may have special coatings that affect the ways in which medication is released into the body, and breaking the coatings by crushing the pills can interfere with the intended rate or route of delivery. For example, crushing tamoxifen might disperse the drug into the air, and inhalation can be dangerous, particularly for pregnant women. Crushing morphine could lead to a fatally fast release of the drug. Nifedipine, an angina and blood pressure drug, can cause dizziness, headaches, or an increased risk of stroke or heart attack if the pills are crushed. Pills may be difficult or impossible to take intact because of their size or because patients have reduced ability to swallow, particularly nursing home residents with multiple medications.
Roger Heilos, a former medical products engineer for Johnson & Johnson, designed the Oralflo Pill Swallowing Cup as a solution. The cup is registered with the FDA as a Class III medical device and has won awards for its unique design. It alleviates discomfort and anxiety associated with pill taking and has become an essential tool for doctor's offices, hospitals, group homes, daycare centers, and concerned family members. Heilos recommends that doctors schedule a follow-up with patients to ask about their ability to swallow pills, which provides an opportunity to offer the pill-swallowing cup or find an alternative route so that medications are not skipped or taken in ways that might endanger patient safety. For more information, to see a photo of the device, or to order the Oralflo Pill Swallowing Cup ($11.95), visit the Web site at http://www.oralflo.com.
Weill Cornell Medical College to Build Alzheimer's-Friendly Virtual Home
The NEC Foundation of America has awarded a $45,000 grant to the Division of Geriatrics at Weill Cornell Medical College to support the development of the Alzheimer's-Friendly Virtual Home, a unique and innovative Web site with graphics-rich information for caregivers on ways to best adapt a home for persons with Alzheimer's disease and related disorders (ADRD) to enhance safety and preserve their independence. Most of the 4.5 million Americans with ADRD currently are cared for at home, primarily by family members. An Alzheimer's-friendly home features modifications to the kitchen, bathroom, stairs, and more. It can make a caregiver's work much easier but can be a challenge to design. Although written information on home modifications is available, Weill Cornell is responding to requests from caregivers for an interactive Web site with three-dimensional animations, videos, and text to properly illustrate the complex process of changing the home to match the stage of the patient's disease. The Web site is expected to go live in 2008. In addition to the NEC Foundation grant, the Alzheimer's-Friendly Virtual Home is funded by a 3-year grant from the Alzheimer's Association ($240,000), a grant from the Retirement Research Foundation ($204,200), and an award from the Helen Bader Foundation ($150,000). For more information, patients may call (866) NYP-NEWS.
Center to Advance Palliative Care Launches New Web Site for Patients and Families Facing Serious Illness
The Center to Advance Palliative Care (CAPC) announced that it has officially launched its new Web site (http://www.getpalliativecare.org) for patients and families. The site is designed to provide patients, family caregivers, doctors, and policymakers with clear, concise palliative care information, which often can be confusing to most consumers. The site is intended to be useful in the decision-making process and includes a comprehensive national directory of hospitals that provide palliative care. The Web site provides clear, easily accessible information and is intended to be user-friendly for adults of any age-even people in their 80s.
Key features of the Web site include the following:
* What is Palliative Care: A clear definition and description of palliative care services, glossary of terms, FAQ, and a pediatric section.
* How to Get Palliative Care: A three-step process for obtaining palliative care services.
* Is Palliative Care Right for You: A brief questionnaire to assist consumers in determining if palliative care is appropriate for them or their loved ones.
* Palliative Care Stories: Stories of patients' experiences with palliative care.
* Clinician Information: A set of criteria developed to help medical practitioners assess whether a palliative care consultation would be beneficial to them and their patients.
* Provider Directory: A comprehensive national directory of hospitals that provide palliative care.
CAPC provides healthcare professionals with the tools, training, and technical assistance necessary to start and sustain successful palliative care programs in hospitals and other healthcare settings. CAPC is a national organization dedicated to increasing the availability of quality palliative care services for people who are facing serious illness. Direction and technical assistance are provided by Mount Sinai School of Medicine. For more information, visit http://www.capc.org.
Aptima and UMass Medical School Collaborate on Handheld Consumer Tool to Help Patients with Chronic Pain Manage Health
Aptima, Inc., a human-centered engineering firm, and the University of Massachusetts Medical School are collaborating on the design and testing of a computer system that will help patients living with chronic pain, such as migraines, back conditions, and osteoarthritis, to better manage their health treatments and interactions with healthcare providers. Aptima and UMass Medical School are teaming on an 18-month, $300,000 grant as one of nine teams selected nationwide to participate in the Robert Wood Johnson Foundation (RWJF) program entitled "Health Design: Rethinking the Power and Potential of Personal Health Records," a $4.4 million initiative.
Dr. Roger S. Luckmann, MD, MPH, Associate Professor of Family Medicine and Community Health at UMass Medical School, will lead the six-person team, which includes four employees of Aptima. The system will include a handheld computer to allow patients with chronic pain to manage personal health activities and information, such as reminders of medication schedules, prompts and guidance for exercise regimens, and a way to track and monitor the impact of various therapies on their psychological well-being. Patients can combine that information with electronic medical records from various healthcare providers, tying together disparate medical information for a complete personal health record.
Aptima was recruited to the team for interaction design and usability assessment and will design the user interface for the handheld device. Over the first 6 months of Project Health Design, teams will participate in a structured process to design user-centered personal health applications that address specific health challenges faced by individuals and caregivers. In the subsequent 12-month phase, prototypes of these personal health tools will be tested with target populations.
Teams were chosen from a pool of more than 165 applicants, and each has been selected to receive an 18-month, $300,000 award. Primary funding for Project Health Design is provided by RWJF's Pioneer Portfolio, which supports innovative projects that may lead to breakthrough improvements in health and healthcare. RWJF is pleased to collaborate with the California HealthCare Foundation, which contributed an additional $900,000 to the initiative. Program activities were launched in December 2006. For further details about UMass Medical School, visit http://www.umassmed.edu. More information about Project Health Design, including a listing of the other program grantees, is available at http://www.projecthealthdesign.org.
Aptima, headquartered in Woburn, MA, combines social science principles with quantitative, computational methods. The company provides products and services focused on the design of organizations, user-centered technology, and training systems. For more information, visit http://www.aptima.com. The University of Massachusetts Medical School is committed to training in the full range of medical disciplines, with an emphasis on practice in the primary care specialties, in the public sector and in underserved areas of Massachusetts. University of Massachusetts Medical School comprises a medical school, graduate school of nursing, graduate school of biomedical sciences, and active research enterprise and is a leader in health sciences education, research, and public service.
The Robert Wood Johnson Foundation is the nation's largest philanthropy and for 30 years has been devoted exclusively to improving the health and healthcare of all Americans. The California HealthCare Foundation, based in Oakland, is an independent philanthropy committed to improving the delivery and financing of healthcare in California.
UCLA Study Finds High Rates of HIV Discrimination in Healthcare
The University of California Los Angeles' Williams Institute on Sexual Orientation Law and Public Policy released a study in January 2007 showing surprisingly high rates of HIV discrimination by healthcare providers in Los Angeles County. The study reported findings from three "testing" studies of skilled nursing facilities, obstetricians, and cosmetic surgeons conducted between 2003 and 2005. Overall, 56% of skilled nursing facilities, 47% of obstetricians, and 26% of plastic and cosmetic surgeons in Los Angeles County would not accept HIV-positive patients for services commonly offered to HIV-negative patients. "The large number of healthcare providers who would readily admit that they would not treat HIV-positive patients is surprising," said Brad Sears, Executive Director at the Williams Institute and author of the study. "Their responses indicate a broad lack of knowledge about the laws prohibiting such discrimination."
The report was consistent with studies from the mid-1990s, which showed high levels of HIV discrimination by dentists and other healthcare providers. Since the late 1990s, few studies have been conducted to measure HIV discrimination in healthcare. The studies were conducted by trained "testers," third-year UCLA law students posing as either HIV-positive patients or employees of organizations working with such patients. Using a script, the testers called the offices of local healthcare providers and asked if they would accept HIV-positive patients. The testers then recorded and coded the responses.
The three types of healthcare providers included in the study were chosen based on current medical needs of persons living with HIV/AIDS, including nursing care as the HIV population ages, cosmetic surgery to address the impact of facial wasting, and prenatal care for women living with HIV/AIDS. The study focused on determining the percentage of providers in each area who had a blanket policy of refusing services to people with HIV/AIDS. The study also provided insight into why healthcare providers refuse to see HIV-positive patients. Some providers justified their policies by their lack of expertise or medical equipment, the fact that they had never treated an HIV-positive patient before, or the fact that their staff were inadequately trained or would "revolt" if asked to treat HIV-positive patients.
Many providers follow a blanket policy of referring all HIV-positive patients to other providers, most frequently by just telling them they need a "specialist" or to "go to a hospital." State and federal law require that such referrals be made on a case-by-case basis after providers have gathered specific information about the health and healthcare needs of the prospective patient. "Many providers are refusing to treat HIV-positive patients and are referring them elsewhere in violation of the ethical rules of their own professional associations," says Sears. "In a couple of cases, the testers followed up on the initial referrals, only to be referred on again and again in a frustrating trail that ended with an absolute refusal of care."
The Williams Institute on Sexual Orientation Law and Public Policy advances law and public policy through rigorous, independent research and scholarship and disseminates its work through various educational programs and media to judges, legislators, lawyers, other policymakers, and the public. The study is available online at the Williams Institute Web site: http://www.law.ucla.edu/williamsinstitute.
Robert Wood Johnson Foundation Announces $115 Million Commitment to Improve Quality of Healthcare in Communities
The Robert Wood Johnson Foundation (RWJF) has announced a 2-year, $115 million commitment to improving the quality of healthcare in communities across the country. The philanthropy, which works to improve the health and healthcare of all Americans, will expand its strategy to improve the quality of care for patients with chronic illnesses by focusing more intensively at the local level. RWJF will also remain active in national efforts to standardize performance measures and public reporting on quality.
On February 1, 2007, RWJF announced all of the communities that are participating under its first regionally focused program involving national coalitions. Aligning Forces: The Regional Market Project, a $14 million program, provides grants and technical assistance to community coalitions to assist their efforts to advance the quality of care provided for chronic illnesses in doctors' offices, clinics, and other outpatient settings. The grantees will each work to help healthcare providers improve their own ability to deliver quality care, help providers measure and publicly report their performance, and help patients and consumers understand their roles in creating demand for better quality care.
The new $115 million commitment will build on the Aligning Forces program and concentrate more intensive resources to improve the quality across the continuum of care (inpatient and outpatient) in targeted regions across the country. RWJF will work in up to 20 communities to improve the quality of healthcare in those communities by focusing more on coordinating care around the needs of patients and reducing racial and ethnic disparities in care. The Foundation will continue to play an active role in national efforts to standardize performance measurement and public reporting so that providers, plans, and consumers increase their understanding of what quality healthcare is and how to achieve it.
For years, RWJF has supported various projects and programs to develop strategies and tools to improve healthcare quality, including funding for the development of quality measures, early pay-for-performance experiments, new models of providing chronic care, and efforts targeted at specific diseases, such as asthma, diabetes, and depression. RWJF also supports the groundbreaking research that has illuminated the problems with healthcare delivery, such as the Dartmouth Atlas Project and the Health Tracking initiative with the Center for Studying Health Systems Change. In recent years, the Foundation's quality portfolio has expanded to include national efforts to improve the quality of care for racial and ethnic minority patients, such as the Expecting Success hospital collaborative, based at George Washington University, and programs such as Transforming Care at the Bedside, which highlight the central role that nurses play in improving patient care. For more information about these and other programs, visit http://www.rwjf.org.
Kaiser Family Foundation Study Shows Medicaid Spending Growth Can Be Sustained by Expected Increases in Government Revenues
As Congress prepares to debate the President's budget and looks ahead to addressing the growing federal deficit and the future sustainability of Medicare, Medicaid, and Social Security, a new study of future funding requirements for Medicaid by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU) projects a less dire situation than suggested by conventional wisdom. The study, authored by Richard Kronick of the University of California, San Diego and David Rousseau of KCMU and published by the journal Health Affairs, concluded that expected growth in government revenues is likely to be large enough to sustain Medicaid spending increases over the next 40 years while also allowing substantial real growth in spending for other public services. The study is available online at http://www.kaisernetwork.org/healthcast/healthaffairs/23feb07.
After accounting for demographic and health coverage trends such as an aging population and declines in employer-sponsored insurance, the study found that Medicaid's share (16.5% in 2005) of national health expenditures is expected to remain at an average 16.6% from 2005 to 2025 and slowly rise to 19% by 2045. As overall health spending increases as a share of gross domestic product (GDP) from 2005 to 2045, however, there will be a commensurate increase in the share of GDP that Medicaid spending represents, according to the study. The results led the authors to conclude that "there is little that is special about Medicaid spending. It is likely to increase with health spending more generally, neither much more quickly nor much more slowly."
Although long-term projections always involve uncertainty, these estimates provide a framework for assessing how future Medicaid spending might be affected by demographic and programmatic changes. The study projected that over the next 40 years, as overall healthcare spending grows, Medicaid will also grow but stay at roughly the same share of national healthcare spending in the coming decades because of three key factors:
1. Although many adults are expected to lose employer coverage, few of them are eligible for Medicaid under current rules, and although more children are expected to enroll in Medicaid, the program's low per-capita spending for children limits the impact.
2. The increase in the number of Medicaid's disabled enrollees drove growth in the program's spending historically, but growth in this population has slowed in the past decade and is projected to remain slow over the next 25 years.
3. The projections assume that nursing home and home health prices will grow roughly at the rate of growth of wages (which grow far slower than healthcare spending), which means that although more elderly people will need long-term care (LTC), Medicaid LTC spending as a share of overall health spending is not likely to increase significantly.
If Medicaid spending and state and federal revenue growth continue to follow long-term historical trends, then state revenues available for non-Medicaid public priorities are projected to grow at an inflation-adjusted 2.5% per year through 2025, roughly the projected rate of inflation-adjusted GDP growth. Even in a scenario in which state revenues did not increase as a share of GDP and Medicaid spending grows more quickly, state revenues for non-Medicaid services would still rise through 2025. Spending pressures will be somewhat greater in the two decades after 2026, but under all but the most pessimistic scenarios, states still can expect substantial revenue growth for services other than Medicaid. The study showed a similar picture for federal revenues, with growth in revenues for non-Medicaid services averaging an inflation-adjusted 2.3% annually from 2006 to 2025, slightly lower than the inflation-adjusted 2.5% if Medicaid spending had remained constant as a share of GDP for the period. The Health Affairs article "Is Medicaid Sustainable? Spending Projections for the Program's SecondForty Years" and an interview with the authors is available at http://www.kff.org/medicaid/kcmu022307pkg.cfm.
The Kaiser Commission on Medicaid and the Uninsured provides information and analysis on healthcare coverage and access for the low-income population, with a special focus on Medicaid's role and coverage of the uninsured. Begun in 1991 and based in the Kaiser Family Foundation's Washington, DC office, the Commission is the largest operating program of the Foundation. The Commission's work is conducted by Foundation staff under the guidance of a bipartisan group of national leaders and experts in healthcare and public policy. The Kaiser Family Foundation is a nonprofit, privately operating foundation dedicated to providing information and analysis on healthcare issues to policymakers, the media, the healthcare community, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.