Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Dianne Conrad

Second Advisor

Evelyn Clingerman

Third Advisor

Simin Beg


The quality of care in the U.S. at the end of life is poor, yet comes with a high price. Since the Institute of Medicine’s (IOM) report Approaching Death in 1997, inpatient palliative care programs in hospitals with 50 beds or more have grown by 165%. In 2015, the IOM had a follow up report, Dying in America that indicates the need for community-based palliative care programs to increase access of care for individuals who are homebound or live in rural communities. In January 2016, the Centers for Medicare and Medicaid Services (CMS) initiated the Medicare Care Choices Model (MCCM) to provide community-based palliative care services to Medicare beneficiaries. A Midwest health system with a hospice and palliative care division has been one of the organizations participating in cohort one. Since initiation in January 2016 through December 2016, 15.93% of patient referred by primary care providers and specialists were admitted to the program and 14.29% were directly admitted to hospice. Therefore, approximately 69.78% of patient referred to MCCM do not qualify or receive supportive, palliative care services within this organization. The development and implementation of a sustainable and feasible evidence-based community-based palliative care (CBPC) program could bridge the gap in care within this organization. Utilizing the Theory of Symptom Management and the Promoting Action on Research Implementation in Health Services (PARIHS) Framework, a toolkit for the development and implementation of a CBPC program for individuals who do not qualify for MCCM was created. This toolkit includes the care model with correlating budgets, pre-post cost-savings analysis, implementation timeline, evaluation tools, and sustainability plan.