Department of Veterans Affairs, West Los Angeles Medical Center

Project Overview

The Center for Patient-Focused Care of the West Los Angeles Veterans Affairs Medical Center implemented a program that improved end-of-life care for veterans diagnosed with terminal illnesses.

"Pathways for Caring" integrated palliative care into its continuum of services for  veterans diagnosed with inoperable lung cancer, advanced chronic obstructive pulmonary disease, end-stage liver cirrhosis or advanced congestive heart failure. Multidisciplinary teams developed care plans, called critical pathways, that provided patient education, informing goal setting, continuity of care and comprehensive clinical and supportive services.

The project focused on symptom control, psychosocial and spiritual care, advanced care planning and overall case management. Multidisciplinary teams, made up of doctors, nurses, social workers, clinicians and pastoral caregivers, worked with volunteers from Compassion in Action to provide palliative care. Veterans who might otherwise be forced to die alone are now more likely to have companionship and comfort in their final days.

The "critical pathways" are a set of protocols that integrate state-of-the-art, hospital-based care with home-based and hospice care. Trinity Home Health and Hospice provided home health care as needed, enabling patients to receive hospital-based as well as home or hospice care according to their needs.

The project contributed to a new end-of-life care curriculum for the University of California-Los Angeles School of Medicine, one of the nation's largest teaching hospitals. The center's cutting-edge computer system is measuring the effect of the project on patient outcomes, the quality of life's end and the cost of care contributing to national efforts to improve end-of-life care.

Tools

• Brochures: Pathways of Caring Program
• Patient Workbook on Lung Cancer
• Patient Workbook on Congestive Heart Failure
• Patient Workbook on Chronic Obstructive Pulmonary Disease (COPD)
• Partial Patient Workbook on Cirrhosis
• Encounter Form Codes
• Case Manager's Comprehensive Patient History and Initial Assessment
• Consultation Notes: Pathways of Caring Program
• Palliative Care Case Management Follow-up Protocol
• After-Death Protocol and Assessment Tools
• Heart Failure and COPD Program Description
• Palliative Care Fellowship Curriculum
• Intake Forms: Pathways of Caring Program
• Palliative Care's Contribution to a Globally Budgeted VA Health System
  The West Los Angeles Veterans Affairs Medical Center is profiled in the Financial Implications of Promoting Excellence in End-of-Life Care monograph.

Resources

• 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 3: Serving Veterans: Opportunities for Creative Collaborations
• The Journal of Palliative Medicine (October 2003: Volume 6, No. 5) features an article about this demonstration project titled "Palliative Care Management: A Veterans Administration Demonstration Project"

After the Grant

Project staff sustained and expanded (with both staff and space) the services to include veterans with all poor prognosis diagnoses. The West LA Veterans Affairs Medical Center received a four-year randomized control trial based on the Pathways program that is anticipated to serve as a basis for national dissemination.

Contact Information

Principal Investigator:
Kenneth E. Rosenfeld, M.D.
Assistant Professor of Medicine
West Los Angeles VAMC
Division of General Internal Medicine
11301 Wilshire Blvd., Mail Code 111G
Los Angeles, CA 90073
Phone: 310.478.3711X41250
Fax: 310.268.4933
Email: kenneth.rosenfeld@med.va.gov
Email: Hosenfeld@yahoo.com

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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.