Goal-Concordant Care Collaboration a Driver in Health Equity Improvement

Some hospices have found success employing more community-based methodologies in their health equity improvement efforts. Forging deeper relationships with other providers and organizations has been integral to reaching underserved patient populations.

Hospices need culturally-informed approaches that respect and understand values across a diverse range of belief systems, said Dr. Kimberly Curseen, the new board of directors president at the American Academy of Hospice and Palliative Medicine (AAHPM). Providers need open lines of communication and deep listening skills to improve goal-concordant care delivery and access, Curseen said.

Curseen is a board-certified in internal medicine, geriatrics, and hospice and palliative medicine physician. She is director of supportive and palliative care of outpatient services for Emory Healthcare and an associate professor at Emory University’s Palliative Medicine Program.

“You have to start with asking not only the providers, but also the patients in that population, about what their values are, the barriers,” Curseen told Hospice News. “It’s the same thought in order to understand how you’re going to deliver more equitable care to different populations. When you set communities as ‘othering,’ you don’t seem them quite like yourself and so there is a separation and missed learned points, even if intentions are good. Accept their values, their structures and choices, and then the solutions become a whole lot more clear.”

Hospices need improved understanding around the barriers to better access and quality among underserved patient populations, said Dr. Ira R. Byock, emeritus professor, at the Dartmouth Geisel School of Medicine and founder of Providence Health System’s Institute for Human Caring.

While increased community engagement plays an important role, also key is more education for clinicians across the care continuum, Byock said during the Annual Assembly of Hospice & Palliative Care, an event by AAHPM and the Hospice and Palliative Nurses Association (HPNA).

Many medical students and new clinicians are not well-versed in holding goals-of-care discussions. Normalizing this communication in their training and across the health care system would go a long way toward better goal-concordant, equitable care, Byock indicated. A significant cultural shift is needed, he said.

“Culture change is really important because when you change the culture, having a goals-of-care conversation with somebody who has a serious illness becomes just normal,” Byock said during the assembly. “It’s not a stretch. It becomes the way we practice. And thus, as people are coming into the organization or changing jobs within the organization, they are assimilated into the new normal.”

Increased care coordination is an important part of improving access across underserved communities, particularly in regions with limited resources in end-of-life support, said Dr. Deborah Unger, director of medical informatics, at Providence’s Institute for Human Caring.

Moving the needle on health equity requires interdisciplinary team communication and can involve staff education and operational investment, Unger said during the assembly. However, these collaborative efforts can reduce costs and improve outcomes across the care continuum.

Employing a collaborative interdisciplinary team approach has resulted in increased goals-of-care conversation rates across Providence’s health system. Goals-of-care documentation rates reached 27% across acute patients in the health system’s intensive care unit in 2024 after a multiyear systematic effort at the health system. This represented an increase from a 2% documentation rate in 2016.

This systemic strategy helped to build a scalable and adaptable framework for goal-concordant care delivery that could be replicated across health care systems nationwide, Unger indicated.

Key drivers of success include a focus on continuous improvement, ongoing staff education and interdisciplinary collaboration, she said. These factors were important to improve trust and widening communication channels across different communities.

“You can only get so far when you incorporate one discipline,” Unger said. “It’s when you start reaching out to other disciplines that it all sort of comes together in that sort of beautiful, almost laced, symphony because people reinforce each other. It really starts to come together as culture change. Collaboration has really been a key driver behind this work. We have spent a ton of time establishing trust and communication channels within Providence, asking people and being responsive to their feedback. We know that these are really true conversations.”