Rural Health Care Services Outreach Program: Okanogan Palliative Care 

The Georgia Health Policy Center recently spoke to Sheila Brandenburg, a registered nurse certified in hospice and palliative care and director of clinical services at Okanogan Palliative Care, about how palliative care is a critical piece of regional care coordination efforts. 

To date, what has been the biggest accomplishment or win in your program? 

We started with a primary set of four guiding principles to build our palliative care specialty here in Okanogan County with the goal of supporting people who are chronically or seriously ill. They were 1) to create the service 2) to build capacity for advanced care planning 3) equity and inclusion in our community and education, and 4) sustainability. The goal that we accomplished that we are the proudest of is sustainability. We were just a random group of people all working in health care and we envisioned a service where we could do this, but our problem was how to integrate into the different healthcare systems. In January 2022, we were able to integrate fully into Family Health Centers, which is a Federally Qualified Health Center. That gave us access to electronic medical records, billing, and community resources. It has been a wonderful fit, and they are an amazing organization to work with. 

What is a tip or early learning that you would share with an organization launching a similar outreach program? 

The biggest thing that we learned is the value of having high-quality partnerships with other organizations in our community. We live in a county with three Critical Access Hospitals, three local health centers, and then all of the government and local health care accessory organizations, but none of them have communicated really well with each other. All had different electronic medical record systems, different phone systems, and different communication strategies. We have learned how powerful it is to set aside time to spend with partners, develop relationships, and have ongoing meetings to align our goals. 

 I was meeting with our local home health and hospice organization for a while, and then they found out that there was a new nurse hired at the Colville Confederated Tribes organization. So, we brought him in, which enables us to now work with the tribal community, as well. I know we hear a lot about partnerships, but in terms of the actual work, this work has been the most beneficial. Relatedly, it has helped to reach out beyond our tiny community and our little service to share information with other people in the state. For an introvert like me, it has been difficult at times, but also just amazing to see how much people are willing to share and contribute to a project that makes a difference in others’ communities. 

How do you see participation in the Federal Office of Rural Health Policy’s Rural Health Care Services Outreach Program impacting your broader health improvement efforts? 

While we have a service where we are actually seeing patients, we also fit into the bigger, broader context of supporting people with serious illnesses. We are now working with another grant-funded program on care coordination, which involves all the hospitals and all the clinics coming together to define what it means to communicate across all spectrums. It is the thing that we are most excited about right now, because it will make everyone’s life easier if we coordinate care. It allows us to do that outreach and education and it will fit that into the plan for their patients coming out of a hospital and going into nursing homes or family homes or back home. Connections occur locally, but we are growing beyond our county, and connecting at the state level and nationally through the work we do with the Office of Rural Health Policy’s Outreach Program. 

What will your organization be doing more of or differently to emerge stronger from the pandemic? 

We were just envisioning how we were going to do our service and making home visits was a part of our service when the pandemic struck. Home visits are a key component because we know that these patients have difficulty getting out of their homes. So, we began adapting home visits using telehealth encounters, sometimes completely virtual, or sometimes a combination of a staff member and provider virtually. Initially, service was difficult due to service issues, and poor connectivity, but the county received support to strengthen the infrastructure and access, even to some of our most remote clients. 

 This difficulty, became a win as we began to use telehealth in a much more rapid manner than we ever would have before the pandemic. Our clients are much more comfortable with the multiple methods we use to stay in touch, follow up, and make visits. 



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