# Identifying Successful Strategies of Specialist Palliative Care Implementation for People with Advanced Heart Failure

> **NIH NIH R01** · YALE UNIVERSITY · 2024 · $590,371

## Abstract

Project Summary
Over 280,000 people die from advanced heart failure each year in the United States. This population
experiences burdensome symptoms, frequent hospitalizations, and delayed transitions to hospice care. Clinical
practice guidelines recommend the use of palliative care for people with advanced heart failure to address their
many palliative needs. However, fewer than 20% receive specialist palliative care, highlighting its markedly
limited reach among this population. Little is known about the palliative care and cardiology program
composition (i.e., structures) or operational characteristics (i.e., processes) that increase the reach of specialist
palliative care or improve care near the end of life. As a result, medical centers nationally struggle to implement
specialist palliative care for people with advanced heart failure and implementation varies widely. Our proposal
will address these critical knowledge gaps. Our long-term goal is to increase the reach of specialist palliative
care and improve the quality of end-of-life care among people with advanced heart failure. As a step towards
this goal, the objective of this proposal is to identify the key modifiable structures and processes of specialist
palliative care delivery that result in high-reach and three end-of-life care outcomes highly valued by people
with advanced heart failure: days at home in the last three months of life, hospice enrollment ≥ 7 days before
death and family-reported end-of-life care quality. To accomplish our objectives, we will conduct a rigorous
multisite, mixed methods study within the Department of Veterans Affairs (VA). The VA is the largest
healthcare system in the United States comprised of 146 nationwide medical centers. Moreover, it is the only
healthcare system with an integrated electronic health record that includes detailed variables on structures and
processes of specialist palliative care, cardiology programs and practices, and surveys of bereaved family
members. We will combine VA data with data from the Centers for Medicare and Medicaid to comprehensively
examine care near the end of life within and outside of the VA. We will evaluate associations between
specialist palliative care and cardiology program structures and processes and the reach of specialist palliative
care (Aim 1), and the three outcomes of end-of-life care quality (Aim 2). Next, we will conduct interviews with
specialist palliative care and cardiology clinicians and analyze policy documents and consultation templates to
identify strategies employed by medical centers that have successfully implemented specialist palliative care
for people with advanced heart failure and compare them to those medical centers that have not (Aim 3).
Finally, we will integrate quantitative and qualitative data to identify comprehensive strategies that facilitate the
implementation of specialist palliative care for this population. This proposal directly aligns with NOT-HL-20-
737, by identify...

## Key facts

- **NIH application ID:** 10849975
- **Project number:** 1R01HL172840-01
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Shelli Leore Feder
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $590,371
- **Award type:** 1
- **Project period:** 2024-09-15 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10849975

## Citation

> US National Institutes of Health, RePORTER application 10849975, Identifying Successful Strategies of Specialist Palliative Care Implementation for People with Advanced Heart Failure (1R01HL172840-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10849975. Licensed CC0.

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