Community-State Partnerships
to Improve End-of-Life Care

Community-State Partnerships to Improve End-of-Life Care was a grant program funded by the Robert Wood Johnson Foundation to promote policy change and support for high-quality, comprehensive end-of-life care. The program was based on the belief that the actions and decisions of individual patients, families and professionals regarding end-of-life care can be greatly enhanced if they take place in a supportive policy context.

Starting in 1998, the foundation awarded $11.25 million to 21 broad-based, multidisciplinary coalitions. Though the program formally ended in 2003, many of the funded coalitions are still active.

The grants supported statewide coalitions working with citizens, healthcare professionals, educators and policymakers and to identify problems, make recommendations and build public support for practical policies, regulations and guidelines to improve care of the dying.

The grant program was housed at the Center for Practical Bioethics, formerly Midwest Bioethics Center in Kansas City, Missouri. Myra Christopher, president and CEO of the Center, was national director of Community-State Partnerships program.

Examples of the diverse areas in which states developed policies include:

• Establishing high-level task forces or commissions that address problems of terminally ill citizens.
  Improving the provision of palliative care, particularly pain control.
• Encouraging medical, nursing and pharmacy schools to include state-of-the-art pain control and palliative care in their curricula.
• Encouraging insurance reimbursement for hospice and comprehensive palliative care.
• Establishing quality standards for care in nursing homes and other institutions that care for frail and terminally ill patients.
• Fostering cooperation and coordination among care providers, including emergency service workers and rescue squads.
• Encouraging a public dialogue about how to solve problems in end-of-life care.

"State policies directly affect so many elements of end-of-life care, including the way physicians prescribe pain medication, the way Medicaid pays for health services and the way medical and nursing schools prepare their students to care for dying patients," said Ms. Christopher. "Community State Partnerships enabled states, the public and health care professionals to work together to develop a vision and strategy for improved care that serves diverse communities."

States receiving grants included Alabama, California, Connecticut, District of Columbia, Florida, Hawaii, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Oklahoma, Rhode Island, Utah, and West Virginia.