C-TAC and the American Heart Association (AHA) launched the “Improving Quality of Life for People with Heart Failure through Integration of Palliative Care Services” initiative in 2023, bringing together a national clinical advisory council, state coalitions, health systems, and health plans in Alabama, California, Hawai’i, and Louisiana to develop a standardized palliative care referral pathway for people with heart failure.
Phase 1
The project is focused on integrating a palliative care referral pathway for people with heart failure into clinical workflows across health systems and health plans in the four participating states. In addition, the project has produced a messaging toolkit designed to educate the public about and promote the benefits of palliative care services.
At the C-TAC-CAPC 2023 Leadership Summit, the project team and members of the national clinical advisory council shared the final referral pathway and criteria based on disease-specific indicators (e.g., Stage C/D, ejection fractions, comorbidities) and unmet needs with symptom management, personal assistance, care coordination and frequent ED and hospital use. Together, these criteria represent a holistic, person-centered approach to care that is aligned with the most up-to-date clinical evidence. Representatives from health plans, health systems, and state coalitions in the four states participating in the planning and implementation portions of this initiative shared data on the design of their pilots.
The health systems and health plans in Alabama, California, Hawai’i, and Louisiana are now in the planning, launch, and implementation stages to test how the referral pathways work in different cardiology outpatient settings and clinical workflows. Most of the sites have selected transitional care clinics, focused on helping people with heart failure who have recently been hospitalized, to pilot implementation.
The goal of the pilot is to educate both heart failure specialists and general cardiologists about the criteria and showcase how patients’ outcomes improve with the extra layer of support palliative care provides. To that end, effective messaging and communications strategies are essential, including using patient stories as concrete examples of how the referral criteria work and how palliative care can be involved. Messaging created for this pilot has focused on stories of people with heart failure who, with palliative care, were able to maintain a high quality of life.
Take home advice for engagement strategies include:
- Do embedded, segmented research to reach the target audience, learn about their needs and wants, the stories they tell, and how they tell them.
- Tailor messages to reflect key learnings and use patient language to demonstrate you heard them.
- Collaborate with partners in community spaces outside of health care to bring messages to where people live their lives.
- Be mindful to curate equitable services, especially those using technological solutions. These approaches can go a long way, but important gaps remain in access to technology, bandwidth, data plans, and digital literacy that must be accounted for during design and implementation.
Phase Two
Now that the pilots are underway, the initiative is looking to move into the next phase of work – the evaluation of the heart failure referral pathway to deliver specialty palliative care consultations to people who meet criteria based on disease burden and palliative care need.
C-TAC and the American Heart Association are seeking funding to support a large-scale evaluation of this referral pathway, as well as to support clinical cross training for cardiologists and palliative care teams participating in the pilot, and to test messaging across the four states to support awareness of the impact palliative care can have on people’s lives.
The goals of the evaluation:
- Finalize an evaluation protocol on the impact of specialty palliative care consultations on experience of care and total cost of care for people with heart failure.
- Monitor and evaluate the heart failure referral pathway across all four sites; ensure fidelity to the pathway and care model.
- Disseminate results, including with health system leadership, health care payers, and interested policymakers.
The outcomes to be evaluated include clinical outcomes, provider experience, patient and caregiver experience, improved quality of life for patients and their families, cost and utilization, and pathway adherence. The project will help build the body of evidence of the benefits of palliative care for people with heart failure, giving more patients access to these critical services, and helping them achieve better outcomes living with a serious illness.
