Objective: To describe the study design and early lessons of an implementation project aiming to make integrated palliative care (PC) a new standard of care across the 33 US Parkinson’s Foundation Centers of Excellence (COEs).

Background: Despite mounting evidence on the benefits of integrated PC approaches for persons with neurologic illness and their families, there are few models of how to implement and disseminate this model of care. This project seeks to implement PC across a large and diverse network of movement disorders centers serving approximately 140,000 patients annually. Our core intervention is based on a successful model of team-based PC that was developed in 3 US Parkinson’s Foundation COEs and validated in a multisite, randomized controlled trial.

Method: We operationalized PC around 5 measurable and actionable pillars (non-motor symptom management, advance care planning, caregiver support, emotional/spiritual support, and timely referral to hospice) to create our core intervention. We followed the Exploration Preparation Implementation Sustainment (EPIS) framework to guide the phases of implementation. Mixed methods and the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework will be used to track the impact and success of implementation efforts.

Results: While healthcare providers were enthusiastic about this project, initial concerns were raised regarding time, need for PC education, care coordination, institutional support and business models. Implementation strategies to be deployed include educational modules, support for local PC champions, quality improvement coaching, creation of PC communities within and across COE, and development of shared central resources through the Parkinson’s Foundation.

Conclusion: There is a need for implementation and dissemination research in neurology. Established implementation science frameworks can be applied to spread complex clinical innovations in neurology practice. The methods and design of this project are relevant to health service researchers and quality improvement faculty interested in increasing uptake of palliative care or other evidence-based interventions.

Abstract to be presented as a poster at the American Academy of Neurology (AAN) Annual Meeting on April 2nd, 2022.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/implementing-team-based-outpatient-palliative-care-in-parkinsons-foundation-centers-of-excellence-coe-study-design/