# Palliative Care as a Parkinson's Disease Standard of Care

> **NIH VA I01** · VA EASTERN COLORADO HEALTH CARE SYSTEM · 2023 · —

## Abstract

Background: Parkinson’s disease (PD) is the second most common neurodegenerative condition among
individuals over the age of 60 years and Veterans are at increased risk of PD due to traumatic head injuries
and exposure to herbicides. PD causes both motor symptoms such as tremor but also distressing nonmotor
symptoms such as depression and pain. These symptoms are associated with reduced quality of life, caregiver
distress, disability, and nursing home placement. Importantly, outpatient palliative care (PC) can improve the
care of patients and their care partners by addressing current gaps in care related to advance care planning,
nonmotor symptom management, caregiver support and psychosocial issues. Significance: The Department
of Veterans Affairs (VA) is uniquely positioned to lead integration of PC into PD care. First, since 2003 VA has
mandated fully staffed PC teams in every VA Medical Center. As a result of this sustained investment, VA has
experienced steady growth in PC consultation volume expanding from primarily inpatient services to growth of
outpatient PC programs. Second, specialized VA centers known as Parkinson’s Disease Research, Education,
and Clinical Centers or "PADRECC” and “Parkinson’s Disease Consortium Centers” comprise the National VA
Parkinson’s Disease Consortium in a hub and spoke model. The PADRECCs operate as hubs with Consortium
Centers serving each VA regional network as spokes to extend the reach of services and serve as ideal sites
to recruit for integration of palliative care. Innovation & Impact: With over 170,000 Veterans affected by PD,
VA has an opportunity to emerge as a leader in providing state-of-the-art PD management. This project will
integrate PC using multiple implementation strategies to improve the key patient and care partner-centered
outcomes in PD and will inform integration of PC into specialty care more broadly. Specific Aims: Aim 1 (Pre-
Implementation) seeks to understand contextual factors and perceived barriers that influence integration,
evaluation and dissemination of PC for Veterans diagnosed with PD using the Practical, Robust
Implementation and Sustainability Model (PRISM). Aim 2 (Implementation) compares the integration of three
core PC components (Advance care planning, Non-motor symptom management, and Veteran and care
partner psychosocial support) into the care of Veterans receiving PD specialty care using “passive”
(education/clinical tools + feedback report) versus “active” (Passive + coaching) strategies. Methodology: The
QUERI implementation roadmap (Pre-implementation->Implementation->Sustainment) guides the proposed
project with use of the theory-based implementation frameworks to inform the intervention and data analysis.
Intervention delivery will occur using covariate constrained cluster randomization of PD sites to the
implementation strategies and the RE-AIM (Reach Effectiveness Adoption Implementation Maintenance)
framework will be applied to understand factors facilita...

## Key facts

- **NIH application ID:** 10753418
- **Project number:** 1I01HX003611-01A2
- **Recipient organization:** VA EASTERN COLORADO HEALTH CARE SYSTEM
- **Principal Investigator:** Cari Renee Levy
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2023
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2023-10-01 → 2027-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10753418

## Citation

> US National Institutes of Health, RePORTER application 10753418, Palliative Care as a Parkinson's Disease Standard of Care (1I01HX003611-01A2). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10753418. Licensed CC0.

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