In late January, there was a cause for celebration at a St. Luke’s clinic in Meridian.
It could have been described as a little bittersweet, but honoring a late colleague’s vision while continuing to serve patients is a rare opportunity and one not to be taken lightly.
For the last three months, an interdisciplinary team has combined forces once a week, embedding Palliative and Supportive Care into the Meridian clinic, St. Luke’s Clinic – Heart Failure.
Being able to further focus on patient-centered approaches was a goal for Dr. Andy Chai, who oversaw the clinic’s creation more than a decade ago. Sadly, Dr. Chai was not able to see the integration of palliative care into the CHF clinic. The beloved cardiologist died Dec. 15, 2021, after battling leukemia.
“There were seeds of it happening, but after Dr. Chai passed, there was a renewed commitment to getting it going, taking the next step in his vision,” said Dr. Jessica Evert, a palliative care specialist. “Part of the passion to make it happen was to honor him and make sure we’re holding true to the clinic’s initiative.”
Evert and Dr. Stefanie Fry, clinical sponsor of the CHF Care Improvement Program and former chair of cardiovascular services at St. Luke’s Boise and Meridian, spearheaded the effort, which also included multiple physician assistants, medical assistants, nurse practitioners and more to be all-in.
“Dr. Evert is a lot like Andy – she’s unstoppable,” Fry said. “This meant a lot to me because it’s something Andy wanted, something we realized could happen right around when he got sick (in 2020), but also, the data is compelling – patients live longer, feel better, are re-hospitalized less … once palliative care is involved.”
Palliative care aims to improve quality of life and provide relief to patients with serious illnesses or health problems. Though it can be implemented at end of life, it also can take place any time when a chronic or acute illness affects a patient’s everyday life.
Embedding in the CHF clinic made perfect sense, as those patients are dealing with it for the rest of their lives and is often progressive. Utilizing a palliative approach alongside disease-modifying treatment in CHF can improve symptom control and better align with a patient’s goals of care.
“We have discussions with our CHF patients about living the best they can with the time they have, or using medical interventions to extend life as long as they can,” Fry said. “In the past, we did not have access to a subspeciality team that is well-trained and well-practiced in doing that. To be able to offer it in our clinical space and it be endorsed by us … we expand our team and doesn’t feel like a shift in gears for those patients.”
It also allows the palliative care and CHF staff to communicate more quickly and efficiently and learn from one another in formal and informal settings. Fry noted it is a case of allowing each group to improve together.
“That’s been an indirect benefit, having different skillsets together lets you collaborate in interesting ways,” Evert said. “And for the patient, there are some difficult conversations, but doing it in a familiar place helps. They know they won’t be abandoned in terms of their specialty care.”
On April 22, the CHF clinic was renamed in Dr. Chai’s honor.
For years, his work and vision will continue. It happened earlier this year with the palliative care team embedded into the clinic, and his legacy will continue to shift – Fry said, “He left us plenty of homework” with further plans to evolve.
“This is huge; it helps our team so much … it is such a wonderful tool to have in our toolbox, to have this team see our patients so we know we can offer them something more,” Fry said. “It’s a cornerstone of his work, this project to involve palliative care in the very core of what we do, and it’s truly transformative.”
Embedding palliative and supportive care into the clinic is not only a great representation of patient-focused clinical integration at St. Luke’s, but hopefully something even bigger for the team.
“We want to increasingly be embedded into specialty and other clinics,” Evert said. “The more we can make it a normal part of the health care journey, the more we can contribute to improving patients’ quality of life.”
Dave Southorn works in the Communications and Marketing department at St. Luke's.