Minnesota Rural Palliative Care Initiative: building palliative care capacity in rural Minnesota

Significant gaps exist in the availability of palliative care in rural hospitals and communities, even though rural populations are often disproportionately elderly and chronically ill. Few studies have examined what models of palliative care would be sustainable in a rural community. We studied the effects of a novel approach to palliative care program development with 10 rural Minnesota community teams over 18 months. The Minnesota Rural Palliative Care Initiative (MRPCI) included a three-prong framework consisting of community capacity theory, a learning collaborative model, and the National Quality Forum (NQF) Preferred Practices for Palliative and Hospice Care Quality. MRPCI confirmed the feasibility of building palliative care capacity in rural communities using this framework. By the end of the 18 months, all 10 teams had identified a target population, developed and refined an action plan, and included at least two strategies to address community needs or gaps related to NQF preferred practices. Only one community had an existing palliative care program at the start of the MRPCI. During the course of the collaborative, five additional communities built a core team to implement a palliative care program. Palliative care development is necessary in rural communities, and envisioning a program that combines structure, accountability, customized guidance, tools, and networking across settings is essential for success.