Date of Award


Document Type


Degree Name

Doctor of Nursing Practice (DNP)

School Name

Donna and Allan Lansing School of Nursing and Health Sciences



Major Advisor

Dr. Linda Cain

Second Advisor

Dr. Joy Lawson

Fourth Advisor

Dr. Karen Cassidy

Fifth Advisor

Dr. Alan Goldbaltt


Advanced Disease Management in Home Healthcare: Palliative Care Integration


With home health caring for patients with serious illnesses and advancing disease states, palliative care in a community setting like the home, can provide many benefits. This population currently has a gap in the healthcare continuum at the point of advancing disease state to end of life care. Recently, new payment models based around clinical outcomes, including hospitalization scores and quality indicators, has caused home health to explore different ways to deliver quality and effective care, especially for those with the highest risk of hospitalization. A literature review was conducted to identify benefits of palliative care integration within home health which revealed improved symptom management, communication around goals of care, end of life and hospice determinations and reduced costs for unnecessary healthcare use. A gap analysis was completed by reviewing the national standards for palliative care and the organizations’ current traditional home health care to determine those gaps in care. Using the evidence-based literature and clinical guidelines, a project was designed to fill the gaps through training and intervention strategies. This project evaluated the training and intervention strategies for home health patients with advanced disease states. Outcomes included learning during project implementation, evaluation of intervention tools, and aggregate hospitalization and improvement in pain scores. Results showed a benefit in the reduction of hospitalization scores and an increase in improvement in pain scores within home health compare results, and significant t-test results related to palliative care needs using a symptom management tool.