Integrated Palliative Care in a Rural Healthcare System

Topic: Palliative Care Models by Setting

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Harris Regional Hospital is an 86-bed acute care hospital based in Sylva, NC which has a population of approximately 2,600. Swain Community Hospital is a 25-bed critical access hospital located 25-miles to the west of Sylva in Bryson City, NC with a population of 1,400. These two hospitals, along with a network of physician practices, outpatient services, and post-acute programs make up a rural, integrated healthcare system serving western North Carolina. In 1995, Harris Regional Hospice was established to provide end-of- life care for the mountainous communities in the far western counties of North Carolina. In 2006, Harris Regional Hospital launched the first interdisciplinary team model of palliative care in the area. The program was re-launched in 2013 with a focus to connect palliative care to all aspects of the continuum of care in this rural environment. The current palliative care service in our rural five county regions includes:

  • Inpatient service comprised of physicians, chaplain, social worker, and nurses providing care to nearly 35% of the inpatient volume on average.
  • Community based service with a full interdisciplinary team providing comprehensive palliative care at home and in skilled nursing and assisted living facilities throughout five counties.
  • Outpatient medical clinic for chronic and advanced illness management, with a sub-focus on pediatric care and rare disorders such as ehlers danlos syndrome.
  • Comprehensive community advanced care planning providing education and consultation in completion of advanced directives.

The palliative care leadership at Harris and Swain have successfully proven the feasibility and sustainability of a comprehensive hospital and community based palliative care service amalgamated in a small, rural healthcare system. Strategic partnerships outside of the health system have also proven invaluable to the success of the program, including partnering with nearly a dozen skilled nursing and assisted living facilities. Internal partnerships with primary care providers and multiple specialists, hospital case management, therapy services, medical ethics, among others have been instrumental in the assimilation of the program across the continuum.

Harris and Swain have demonstrated the positive business impact credited to the palliative service, with significant revenue increases for the hospice program. Additional volume has also been noted for the home health service, in partnership with our home palliative care. These successes are a result of appropriate transitions of care within our community health system continuum, coordinated by the palliative care team. Quality of care outcomes attributed to the palliative care program include reduced hospital re-admissions, impact on patient satisfaction, and exemplary feedback from referring physicians. These achievements are all the product of an integrated palliative program with a rural hospital system, rural home health service and rural hospice all in one organization.

Future palliative care development for this rural system will include a multi-disciplinary clinic in partnership with Western Carolina University to provide medical, nursing, social services, nutritional counseling, physical therapy, and other comprehensive care services to patients with advanced illness and support educational opportunities for students in the health sciences disciplines.

Author

  • Morgan Allen, CHPCA
  • Administrative Director
  • Harris Regional Hospital and Swain Community Hospital
  • 68 Hospital Road
  • Sylva, NC 28779
  • (828) 631-1702

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