Mount Sinai School of Medicine

Project Overview

Mount Sinai School of Medicine's Henry L. Schwartz Department of Geriatrics and Adult Development, in New York collaborated with Franklin Health, Inc., a national medical case management service, and Blue Cross/Blue Shield of South Carolina to integratepalliative care protocols into the disease management system for commercially insured patients nearing the end of their lives.

Palliative care focuses on comfort as well as the psychological, social and spiritual well being of patients and their families. Case management is an increasingly popular strategy that applies "best practice" clinical protocols to improve the consistency and quality of care for people with specific serious illnesses.

The case management protocols developed under this grant focused on palliative care for high-risk homebound patients with life-limiting illnesses. Under this program, Franklin Health case managers used protocols for symptom management and for assisting patients with decision making and counseling. Used within the managed care environment, this approach enhanced quality and patient satisfaction, while controlling costs.

Led by principal investigator Diane E. Meier, M.D., associate professor and director of the Palliative Care Program at Mount Sinai School of Medicine, and William Thar, M.D., M.P.H., director of research and product development at Franklin Health, the project, Integrating Community Case Management and Palliative Care also created training modules for nurse case managers.
To determine the impact of the program, researchers at Mount Sinai assessed the quality of care, as well as the quality of life of dying individuals, and cost-effectiveness of the strategy.

Tools

• Treatment of Symptoms Distress: Cancer Anorexia/Cachexia
• Treatment of Symptoms Distress: Constipation
• Treatment of Symptoms Distress: Delirium
• Treatment of Symptoms Distress: Fatigue
• Treatment of Symptoms Distress: Nausea and Vomiting
• Treatment of Symptoms Distress: Normal Sleep and Insomnia
• Treatment of Symptoms Distress: Anxiety and Cancer
• Treatment of Symptoms Distress: Opiates
• Modified Edmonton Symptom Assessment Scale
• Mount Sinai/Franklin Health Communication Instrument
• Franklin Health Complex Care Management Patient Satisfaction Study
• Franklin Health Physician Survey
• Missoula-VITAS Quality of Life Index

Resources

• Bibliography (PDF 60 KB / 1 page)
  Download Acrobat Reader
• State-of-the-Art in Palliative Care Management
  Mount Sinai School of Medicine and Franklin Health, Inc. are profiled in the Financial Implications of Promoting Excellence in End-of-Life Care monograph.
• Journal of Palliative Medicine, 7(1): February, 2004 features an article about this demonstration project titled "Integrating Case Management and Palliative Care"
• This demonstration project was featured at the 2003 NHPCO 18th Management and Leadership Conference:
  • Session 1: Concurrent Care - New Models and Successful Strategies for Aligning Access, Quality and Costs
• Session 2: Making the Right Way the Easy Way

After the Grant

Franklin Health, now called Paradigm Health, maintained and extended this program to all clients, implementing it in health plans and self-insured plans covering five million lives.

Contact Information

Principal Investigator:
Diane E. Meier, M.D. and William Thar, M.D., M.P.H.
Mount Sinai School of Medicine
Box 1070
New York, NY 10029-6574
Phone: 212.241.6796
Fax: 212.426.5054
Email: diane.meier@.mssm.edu
Email: bill.thar@paradigmhealth.com

Web site: www.capcmssm.org

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Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families.