PPC Catalyst Program: Model for Sustained Culture Change Across Specialties

Key Message: Innovative approaches are needed to deliver quality primary palliative care (PPC). Developing systems of care and provider training are essential components to achieve this goal. We sought to understand the impact of specialty-specific physician champions on key measures of success over there year period: physician documented goals of care conversations.

Abstract:

Introduction:
Innovative models are still needed to scale Primary Palliative Care (PPC) across specialties. We describe a novel approach to scaling PPC across a large integrated healthcare system serving an estimated 4.6 million members.

Methods: We formed a team of PPC Catalysts from 16 service areas in January 2022 from specialties including Adult Family Medicine, Oncology, Hospital Medicine, Critical Care, Specialty Palliative Care and Emergency Medicine. The Catalysts were given dedicated time to provide training locally and to share culture change learnings with peers at monthly community of practice meetings.

Catalysts received onboarding to Supportive Care services including Advance Care Planning, Primary and Specialty Palliative Care and Hospice. Each PPC Catalyst attended Vital Talk Faculty training and completed CAPC modules to develop serious illness symptom management competencies. Catalysts were given dedicated time to support local efforts to change culture and support patients with serious illness. Key measures of success of the program included physician documented goals of care conversations.

Results: There has been a 208% increase in documented goals of care conversations from launch of the program in January 2022 to December 2024 with goals of care conversations documented by physicians practicing within Emergency Medicine, Hospital Medicine, Oncology, Critical Care and Geriatrics. VitalTalk Trainings delivered by PPC Catalysts consistently impact provider self-efficacy in delivering serious news and creating a values-concordant treatment plan.

Conclusion
The PPC Catalyst model demonstrates a scalable, specialty-integrated approach to improving serious illness care. With sustained improvements over three years, this model offers a replicable framework for health systems aiming to embed primary palliative care into routine practice. The impact of the PPC Catalyst program on measures of success has continued over three years with sustained behavior change impact.

References: Quill TE, Abernethy AP. Generalist plus specialist palliative care--creating a more sustainable model. N Engl J Med. 2013 Mar 28;368(13):1173-5. doi: 10.1056/NEJMp1215620. Epub 2013 Mar 6. PMID: 23465068.
Empowering Primary Palliative Care to Sustain Specialist Palliative Care. Guthrie, Richard V. Mayo Clinic Proceedings, Volume 98, Issue 9, 1423 - 1425