Intervention Examples: Project Profiles

The table below outlines the projects from the nine California public health care systems that piloted interventions with support from CHCF’s generalist palliative care implementation program in 2020–21. It is organized by the three major categories of behavior change and skill-building these teams focused on: advance care planning and goals of care discussions, pain assessment and management, and comfort care at the end of life.

In the table, each organization’s entry links to a project profile that includes a project overview, description of the target patient population and project activities, summary of key challenges and takeaways, and description of core measures and select outcomes.

These approaches can be adopted or adapted by any health care system that aims to improve the care of its patients with serious illness.

CHCF Generalist Palliative Care Implementation Projects

Public Hospital	Partner Service Line	Target Audience	Target Population	Project Activities
Target Behavior: Advance Care Planning (ACP) and Goals of Care (GOC) Discussions
Alameda Health System (PDF)	Emergency department	Residents	Seriously ill patients	Communication skills training (VitalTalk) Electronic health record (EHR) SmartPhrase to document and track discussions Incentives and public reporting to encourage discussions
UC Irvine Health (PDF)	Emergency department	Attending physicians, fellows, residents	Seriously ill patients	VitalTalk’s emergency medicine training and Mastering Tough Conversations training VitalTalk’s Faculty Development courses GOC SmartPhrase created for EHR reminder
Zuckerberg San Francisco General Hospital and Trauma Center (PDF)	Trauma surgery	Attending physicians, fellows, residents, and nurse practitioners	Seriously injured patients	Internally developed training on screenings, new workflows, and communication skills training; recorded trainings and videos developed for integration into curriculum EHR SmartLists and dot phrases created for documentation; integrated ACP and health proxy into history and physical template Activities based on American College of Surgeons’ Trauma Quality Improvement Program Palliative Care Guidelines
Contra Costa Health Services (PDF)	Primary care	Primary care providers	Seriously ill or older adults	Internally developed training on introduction to ACP, GOC discussions, and revised workflows for primary care providers, combined with self-paced Center to Advance Palliative Care (CAPC) training modules ACP reminder created in EHR primary care dashboard with links to ACP documentation notes; included as a quality incentive program measure
Harbor-UCLA Medical Center (PDF)	Cardiology clinic	Nurse practitioners and social worker	Congestive heart failure clinic patients	Internally developed training on palliative care basics combined with VitalTalk’s Mastering Tough Conversations training Palliative care consults provided as needed plus mini-refreshers on training topics EHR stores completed forms and identified surrogate decisionmaker; internal log of ACP activity also tracks patients reached
Santa Clara Valley Medical Center (PDF)	Nephrology clinic	Physicians and social workers	Patients age 70 and older with advanced chronic kidney disease	Internally developed training on ACP and Physician Orders for Life-Sustaining Treatment combined with VitalTalk’s Mastering Tough Conversations training VitalTalk’s Faculty Development courses completed by nephrologist and palliative care chief for sustainability Mentoring provided by palliative care via shadowing and case conference — focused on “micro conversations” and the process for ACP Tracked in EHR via shared lists and documented goals of care in notes
Target Behavior: Pain Assessment and Management
LAC+USC Medical Center	Radiation oncology	Residents and nurse practitioners	Radiation oncology clinic patients	Internally developed training on assessing, documenting, and managing pain combined with required self-paced CAPC training modules; shared all resources via SharePoint Mentoring and consulting from chief resident and palliative care team EHR dot phrases created to integrate pain assessment and plans into resident workflow
Olive View-UCLA Medical Center	Medical oncology clinic	Fellows and attending physicians	Oncology clinic patients with solid tumors	Internally developed training sessions on pain assessment and management (including the PEG [pain, enjoyment of life, and general activity] scale and new workflow) combined with access to CAPC training modules Real-time mentoring from the palliative care team PEG tool stored as ad-hoc form; proposing EHR modification to include in routine pain documentation
Target Behavior: Comfort Care at the End of Life
UC San Diego Health (PDF)	Neurology	Neurology	Patients nearing the end of life	Internally developed training series on palliative care and hospice, communications skills, and symptom management; combined with simulation case training and CAPC modules. All resources available online on resident website. Consults available with palliative care team as needed Neuropalliative care elective created for residents for two-week rotation with palliative care team Comfort care orders, advance directives, and consults tracked in EHR

Essential Skills and Supports for All Clinicians Treating Serious Illness

Project Profiles from California Public Health Care Systems