The Development and Implementation of a Cardiac Home Hospice Program: Results of a RE-AIM Analysis

Background: Use of hospice has grown among patients with heart failure; however, gaps remain in the ability of agencies to tailor services to meet their needs. Aim: This study describes the implementation of a cardiac home hospice program and insights for dissemination to other hospice programs. Design: We conducted a multimethod analysis structured around the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework. Settings/Participants: We used electronic medical records for our quantitative data source and interviews with hospice clinicians from a not-for-profit hospice agency (N = 32) for our qualitative data source. Results: Reach—A total of 1273 participants were enrolled in the cardiac home hospice program, of which 57% were female and 42% were black or Hispanic with a mean age was 86 years. Effectiveness—The cardiac home hospice program increased hospice enrollment among patients with heart failure from 7.9% to 9.5% over 1 year (2016-2017). Adoption—Institutional factors that supported the program included the acute need to support medically complex patients at the end of life and an engaged clinical champion. Implementation—Program implementation was supported by interdisciplinary teams who engaged in care coordination. Maintenance—The program has been maintained for over 3 years. Conclusion: The cardiac home hospice program strengthened hospice clinicians’ ability to confidently provide care for patients with heart failure, expanded awareness of their symptoms among clinicians, and was associated with increased enrollment of patients with heart failure over the study period. This RE-AIM evaluation provides lessons learned and strategies for future adoption, implementation, and maintenance of a cardiac home hospice program.