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Providing Palliative Care to Patients Throughout the State of Indiana from a Centralized Virtual Palliative Care Hub


By Eric N. Shepard, MD and Areeba Kara, MD, MS, FACP

“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.”

This commitment so beautifully articulated by Dame Cicely Saunders continues to encapsulate the goals of palliative medicine. As the population ages and cutting-edge care allows more patients to live with life-limiting illnesses, the need for palliative medicine continues to grow. However, specialized palliative care clinicians are a limited resource in the United States and in the state of Indiana with long appointment wait times.

Access to palliative medicine is further constrained by the need to travel to appointments to sites that are often localized to urban, academic centers. Travel can add a new burden for patients and families who are already navigating frailty, serious illness, complex care and coordination.

Along with our colleagues, we sought to ease these burdens and expand the accessibility of palliative care throughout Indiana through a centralized virtual hub. We describe our experiences in our manuscript published in the December 2022 issue of The Joint Commission Journal on Quality and Patient Safety.

Prior to the onset of the COVID-19 pandemic, funding was provided for the expansion of palliative care services through a virtual platform to broaden the reach of palliative care. A centralized virtual palliative care hub was established, providing palliative care consultation to patients in multiple settings, including:

  • critical access hospitals (those with less than 25 beds and are at least 35 miles from another hospital)
  • outpatient visits directly to patients in their homes
  • extended care and rehabilitation facilities

We aspired to create a space where patients and their loved ones could discuss the care they are receiving, the hopes and goals for their care, advance care planning, as well as to help address distressing symptoms, while meeting them where they are.

Over 12 months we were able to serve 372 patients. Two hundred seventy-five patients (73.9%) were seen in the outpatient setting and 97 patients (26.1%) were seen in the inpatient setting at one of eight critical access hospitals. We were able to serve patients across the state and assist in the completion and verification of advance directives for 286 patients (76.9%) as well as help refer and transition 107 patients (28.8%) to hospice care.

Our hope is that our manuscript can serve as a guide for other providers and clinicians around the country and globe in finding novel ways to meet and serve patients living with serious illness or at the end of life who need their care. We hope to continue to grow our service over time to have an interdisciplinary team, including social work and chaplaincy, as well as fill gaps for those who still may not be able to see a palliative care provider.

Eric N. Shepard, MD, is a Palliative Care Physician at Indiana University Health (IU Health) in Indianapolis. Dr. Shepard also is Assistant Professor of Clinical Medicine in the Division of General Internal Medicine and Geriatrics at Indiana University School of Medicine.

Areeba Kara, MD, MS, FACP, is a Hospitalist at IU Health and Associate Professor of Clinical Medicine at Indiana University School of Medicine. Dr. Kara also serves as the Associate Division Chief of the Division of Internal Medicine and Geriatrics.