Promoting Excellence in End-of-Life Care was a program to identify, promote and institutionalize care practices that allow seriously ill people and their families to approach the end of life in physical, psychological, spiritual and emotional comfort.

RWJF established a national program office at the Center for Ethics at the University of Montana at Missoula to manage Promoting Excellence and provide technical assistance to participating organizations.

The program's goals were to:

• Support innovative models of palliative and hospice care for people and in settings where they were underutilized or unavailable.
• Support initiatives to provide quality palliative care earlier in the course of illness, concurrent with life-extending care.

Key Results
Promoting Excellence supported:

• Twenty-two demonstration projects that created new models of palliative care.
• Four demonstration projects that tested models of delivering palliative care within hospital intensive care units.
• Eight disease- or issue-specific workgroups that brought health care leaders together to generate new ideas for their fields.
• Special Opportunities Fund grants that supported nine projects addressing gaps in knowledge or practice.
• A comprehensive communications strategy.

According to the national program office staff, Promoting Excellence in End-of-Life Care demonstrated that:

• It is possible to change the way health care professionals approach their work with people who are dying and their loved ones.
• Palliative and curative care can be provided concurrently.
• Projects integrating curative and palliative care can be sustained, replicated and expanded.

Staff at the national program office and participating projects reported the following key site results:

• Several hospitals, state agencies and hospice organizations changed their practices by adding palliative care staff to medical teams; using decision-making tools that address patient emotional and spiritual needs, as well as medical needs; and creating and utilizing new curricula for medical provider and community organizations. See Site Profile on FOOTPRINTS^sm in St. Louis for details.
• At least two projects increased access to palliative care by securing additional insurance coverage for those services.
• At least two projects demonstrated cost savings by reducing inpatient admissions, hospital stays and readmissions. See Site Profile on Project Safe Conduct in Cleveland for more details.
• Several projects demonstrated that they improved patient outcomes by reducing pain, increasing the proportion of patients who die at home rather than in hospitals and serving patients with diseases, such as heart failure, that hospice has traditionally failed to reach. See Site Profile on Pathways of Caring at the West Los Angeles Veterans Affairs Medical Center for more details.
• Costs did not increase in the Promoting Excellence projects, although costs of health care in the last six to 12 months of life remained high, commensurate with the complex needs of people who are seriously ill. In fact, in the projects able to track resource use or expenditures, total health care costs were moderately reduced, even with the provision of concurrent palliative and curative care.
• The eight workgroups each published Recommendations to the Field reports, some of which were adopted by medical specialty organizations as practice standards.
• The Journal of Palliative Medicine published a 19-article series showcasing 17 Promoting Excellence projects and the national program office.

Funding
In July 1996, the Board of Trustees of the Robert Wood Johnson Foundation (RWJF) authorized up to $15 million to support Promoting Excellence.