The primary goal of this proposed K99/R00 Pathway to Independence Award is to build on the PI?s current skillset and strong research foundation to enhance her development into a uniquely-trained investigator. This will be made possible by the training, mentoring, formal education, and professional opportunities of the K99/R00 award and will facilitate the PI?s transition into a tenure-track faculty position. The PI has set forth an ambitious research, mentoring, and training agenda that aims to fill current gaps in her skillset. The expected result is a dynamic, well-trained, mixed-methods investigator that will be well positioned to meet the changing needs of palliative care, person-centered care, and health systems research related to older adults and those with serious illness. The PI?s career goals are to obtain a tenure-track faculty position at a research-oriented university, conduct high-impact independent research projects, and be an international leader in health systems and implementation research. This study will undertake an effort to address the two-pronged gap in providing palliative care in the U.S. (episodic care and misaligned financing structures). This will be done by implementing an evidence-based Home-Based Palliative Care (HBPC) model?originally developed in managed care?into primary fee-for- service as a covered health benefit; the very first translation of this model by a private health insurer in the U.S. The purpose of the present study is to investigate the provider and organizational-level impact of implementing reimbursable HBPC in primary care with the goal of characterizing a set of implementation strategies and eliciting key mechanisms on how to widely replicate person-centered, reimbursable HBPC in primary care settings across the country. To this end, seven research questions will be answered that address the study purpose pertaining to feasibility, barriers, facilitators, person- centeredness, and job satisfaction. Guided by the Diffusion of Innovations theory, a matched-control design among four study sites implementing either the HBPC intervention or enhanced usual care (telephonic case management) is proposed. The methodological approach consists of two components: 1) Primary collection and analysis of qualitative focus group data at each study site, and thematic analysis of telephone-based mentoring sessions at the two intervention sites; and 2) Development, validation, and implementation of quantitative tools to measure person-centered care and job satisfaction among providers. Key outcomes for the qualitative component include feasibility, barriers, and facilitators of translating HBPC, as well as characteristics associated with rate of HBPC diffusion and implementation strategies. Outcomes for the quantitative piece include validated measurement tools for provider perceptions of person-centered care and job satisfaction. This project challenges our current approach to fee-for-service palliative care and seeks to shift current research. Nation-wide replication of reimbursable HBCP models is anticipated.
This research challenges our current approach to fee-for-service palliative care and is significant because it will advance the fields of palliative and person-centered care, clinical practice, public policy, and health care financing. However, the most important effect will be on seriously ill patients and their families through increased access to palliative care outside of hospitals, enhanced palliative continuity across health settings, and improved affordability via reformed payment structures. Nation-wide replication of reimbursable HBCP models is anticipated.
