# Evaluating the Implementation of Specialist Palliative Care for Patients with Advanced Heart Failure

> **NIH NIH R56** · YALE UNIVERSITY · 2023 · $571,493

## 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 persons with advanced heart failure to address this
population's many palliative care needs. However, nationally the uptake of specialist palliative care remains low,
and implementation across hospitals varies widely, limiting effectiveness. As hospitals move to implement
specialist palliative care into clinical practice for persons with advanced heart failure, there is little evidence to
guide them as to what components are necessary or how to implement this care. Without such information, the
uptake of specialist palliative care will remain low thereby contributing to poor care at the end of life. Our
proposed project will address these critical knowledge gaps. Our long-term goal is to increase the low uptake of
specialist palliative care and to improve end-of-life care quality among people with advanced heart failure. As a
step towards this goal, the objective of this proposal is to identify modifiable factors and implementation strategies
that medical centers can use to develop specialist palliative care programs for this population, beginning in the
Department of Veterans Affairs (VA). The VA is the largest healthcare system in the United States and is the
only healthcare system whose integrated electronic health record supports a rigorous and comprehensive
evaluation of specialist palliative care delivery involving features of both palliative and cardiology practices. To
accomplish our objectives, we will use a multisite, sequential, explanatory mixed methods design and a positive
deviance approach. We will evaluate associations between specialist palliative care and cardiology program
composition (i.e., structures) and operational characteristics (i.e., processes) and the uptake of specialist
palliative care (Aim 1) and important outcomes of end-of-life care quality including hospice enrollment before the
last seven days of life, and family-reported end-of-life care quality (Aim 2). We will accomplish these aims using
a novel dataset comprised of patient and hospital-level data from 83 VA medical centers, detailed data on
structures and processes of specialist palliative care and cardiology programs, and surveys of bereaved family
members combined with Medicare and Medicaid claims. Next, we will compare structures, processes, and
implementation strategies across twelve medical centers by conducting interviews with specialist palliative care
and cardiology clinicians, and through the analysis of policy documents and consultation templates (Aim 3). We
will integrate quantitative and qualitative data (Aim 4) to identify strategies that facilitate the effective delivery
and implementation of specialist palliative care for persons with advanced heart failure. Thi...

## Key facts

- **NIH application ID:** 10930192
- **Project number:** 1R56HL166523-01A1
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Shelli Leore Feder
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $571,493
- **Award type:** 1
- **Project period:** 2023-09-23 → 2024-09-14

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10930192

## Citation

> US National Institutes of Health, RePORTER application 10930192, Evaluating the Implementation of Specialist Palliative Care for Patients with Advanced Heart Failure (1R56HL166523-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10930192. Licensed CC0.

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