Washington Rural Palliative Care Initiative

In 2016, the Washington State Office of Rural Health convened a planning group to discuss how to integrate palliative care in rural communities.

The overarching goals of this initiative are to:

  • Assist rural health systems and communities to integrate palliative care in multiple settings, such as emergency department, inpatient, skilled rehabilitation, home health, hospice, primary care, and long term care
  • Better serve patients with serious illness in rural communities
  • Create sustainable funding for palliative care.
  • Develop a structure that can assist successive waves of rural health care organizations to develop palliative care within a peer community of practice.
  • Move upstream to serve patients with serious illness earlier in their experience of illness.

The model has six components:


Community engagement

A local team with members from diverse organizations assess current assets and gaps for palliative care and develop an action plan. Communities commonly target objectives and activities within and outside the health system such as beginning clinical screening, launching a new service, public education, volunteer services, or improved coordination. Community teams also develop action plans to increase non-medical supports for community members with serious illness, such as home adaptations or meals or transportation.

Clinical training and technical assistance

Clinical training and technical assistance facilitates culture change within the rural health system. Strategies include skills training, change management technical assistance, mentoring, facilitation, gathering of evidence, clinical standards, and support for design of workflows. The interdisciplinary team shepherds data-driven process improvements leading to targeted outcomes.

Telehealth case consultation pilot

In June, 2018 a telehealth case consultation pilot began using an expert interdisciplinary palliative care team on a HIPPAA compliant platform, consulting on clinical cases from the seven cohort teams. Our Nursing Coordinator screens and organizes the cases, prepares the expert team, and facilitates the consultation process.

Clinical telemedicine for patients and families

Telehealth case consultation prepares for the fourth element, clinical telemedicine for patients and families. Initially, healthcare organizations will serve as an originating site and with an eventual addition of home-based telemedicine telemonitoring.

Financial sustainability

Financial sustainability is critical and the fifth arm of the initiative strategies, achieved through conversations and education of payers, policy work, billing knowledge management and using credible metrics to measure impact.

Development of Rural Centers for Palliative Care Excellence

The sixth domain is the eventual development of Rural Centers for Palliative Care Excellence with structured recognition and dissemination strategies to aid the spread of rural palliative care.

Advisors, supporters and participants include:

Stratis Health, Amerigroup/Anthem, Washington State Department of Health State Office of Rural Health, University of Washington (WWAMI, Family Medicine, Palliative Care), Washington State University Elson S. Floyd College of Medicine, Providence St. Joseph Health, Northwest Telehealth at Inland Northwest Health Services, The Northwest Regional Telehealth Resource Center, Heartlinks Hospice & Palliative Care, The Lookout Coalition, Jefferson Healthcare, Columbia County Health System, Newport Hospital and Health Services, Pullman Regional Hospital, Columbia Basin Hospital, Whitman Hospital and Medical Center, Home Care Association of Washington, Northwest Rural Health Network, Washington State Hospice and Palliative Care Organization, Qualis Health, Washington State Hospital Association, Molina, Coordinated Care, Regence Blue Shield, and Washington State Health Care Authority.

Community team contributors include:

Whitman Public Health, Walla Walla Community Hospice, Friends of Hospice, Assured Home Health and Hospice-Moses Lake, Aero Methow Ambulance, Confluence Health, Frontier Home Health and Hospice, Family Health Centers, McKay Healthcare and Rehab Center, Rural Resources, Pullman Family Medicine, Palouse Medical, Kindred Hospice, Pullman Fire, Bishop Place Senior Living, Regency Senior Living Care, Columbia Basin Family Medicine, Three Rivers Hospital, Mid-Valley Physician Group, Confluence Health, Blue Mountain Counseling, Elk Drug, Dayton Food Bank, Providence St. Mary’s Palliative Care, Home Health, Aging and Long-Term Care, Dayton Christian Church, Dayton Methodist Church, Walla Walla Community College, Redeemer Lutheran Church of Dayton, and Coolidge House.