Hillman Innovations in Care Program
The Hillman Innovations in Care (HIC) Program (launched in 2014) is a multi-year initiative that supports the advancement of leading-edge, nursing-driven models of care that improve the health and health care of vulnerable populations, including the economically disadvantaged, racial and ethnic minorities, LGBQT, the homeless, rural populations, and other groups that encounter barriers to accessing health care services. Two multi-year HIC grants of up to $600,000 are awarded annually.
(For information on how to apply please refer to the Applicants section located to the right of this page)
"The Hillman Innovations in Care Program provides a powerful boost to promising but under-recognized models of care delivery," said Mary Naylor, PhD, RN, Marian S. Ware Professor in Gerontology at the University of Pennsylvania School of Nursing, who has already received support from the Foundation for her nurse-led Transitional Care Model. "It is these kinds of innovations that have the potential to help our health care system to achieve several key outcomes – better health, higher patient and caregiver satisfaction, and lower costs."
A Nurse-Driven Telehospice Program for Underserved Rural Populations. Four Seasons Compassion for Life, Flat Rock, North Carolina (Principal Investigator: Michelle Webb, MSN, RN, CHPCA) The HIC grant will leverage Four Seasons’ federally funded tele-palliative care model to develop a program providing remote, in-home hospice services to people in western North Carolina. Four Seasons serves a number of rural, low-income counties in a geography and climate that does not allow for consistent, coordinated health care and poses numerous challenges for nurses charged with regular hospice care home visits.
Hillman funds will be used to improve patient and family satisfaction and health outcomes by implementing a care management portal to be used in conjunction with the telehospice program. Specially trained nurses will seek to efficiently and cost effectively provide hospice care by remotely addressing symptom and pain management, medication adherence, advance care planning, and spiritual and psychosocial needs. Visits will be conducted using TapCloud, a HIPAA-compliant app, and a web-based video conferencing service. Patients and/or their caregivers (including long-distance caregivers) will enter information on symptoms and medication use via patient portal software, and nurses, together with the interdisciplinary hospice team, will use this information, along with online vital sign measurement, to monitor progress, adjust treatments, and determine when in-person visits are needed to improve the patient’s overall care.
Empowering Seriously Ill African Americans with Resources to Meet Their Spiritual, Social, and Advanced Care Planning Needs. University of California, Davis – Betty Irene Moore School of Nursing (Principal Investigators: Janice Bell, RN, MN, MPH, PhD, UC Davis and Rev. Cynthia Carter-Perrilliat, MPA, Alameda County Care Alliance) Hillman funding will help to expand, evaluate, and sustain the Advanced Illness Care Program (AICP), a highly creative, faith-based, nursing-driven intervention developed in partnership with the Alameda County Care Alliance and the Public Health Institute. Since its inception in 2013, the program has trained and placed care navigators in five African-American church communities in Oakland, California. The care navigators provide referrals and care not only to congregants and their caregivers, but to persons with advanced illness in the community. Care navigators offer support with basic needs such as food, housing, or transportation, and help people access social services; spiritual support; respite, palliative and hospice care; and complete advance care plans. The intervention includes a baseline home visit and assessment, follow-up visits, and additional telephone support.
The team will use the funding to expand the program to three church communities, doubling the impact and enrolling an additional 500 congregants, community members, and family caregivers. Funding will also be used to train care navigators and volunteer care ministers, to promote the program through community outreach, and to support ongoing data collection that has provided evidence of the program’s success. Partnerships with Kaiser Permanente and the Washington DC-based C-TAC (Coalition to Transform Advanced Care) will contribute to the spread and scale of the model.
Transitional Care for Homeless Populations. Project Access of Durham County (PADC), North Carolina (Principal Investigators: Julia Gamble, MPH, NP and Donna J. Biederman, DrPH, MN, RN) The Hillman Innovations in Care grant is helping to grow and further develop the Durham Medical Respite Program, a nurse-led, community based initiative which provides safe and supportive respite housing to homeless persons who require a place for healing following discharge from a hospital, behavioral health, or jail setting.
Hillman funds help to broaden the role of nurse care coordinators and community health workers, who, in addition to connecting patients to health care for chronic and acute conditions, help patients navigate access to housing and other benefits. Nursing students and other health professionals are invited to participate in educational events tailored to the care of populations experiencing homelessness or housing instability. The overall goal of the program is to improve the health and quality of life of the homeless and those with housing insecurity experiencing care transitions; and to reduce costs, resources, and care provider burnout.
“The Durham Medical Respite Program addresses a pressing unmet need to offer safe discharge options for homeless persons who are too sick for the streets or a shelter, but not sick enough to qualify for continued hospitalization,” said Bobbie Berkowitz, PhD, RN, Dean of the Columbia University School of Nursing and chair of the Foundation's review committee. “The connection between lack of housing and poor health is evident and substantiated, and the Durham Medical Respite Program addresses this challenge using a promising model that could be replicated in other communities across the United States.”
A Public Health Nursing/Legal Partnership Serving Low-Income Mothers and Babies. National Nursing Centers Consortium (NNCC) Philadelphia Nurse-Family Partnership (Principal Investigator: Katherine Kinsey, PhD, RN, FAAN) Hillman funding has helped to establish a community-integrated Public Health Nursing/Legal Partnership (PHNLP), which serves the health and social needs of low-income mothers and babies in Philadelphia. Public health nurses from NNCC’s Philadelphia Nurse-Family Partnership/Mabel Morris Family Home Visiting Program (NFP/MM), collaborate with lawyers from the Health, Education and Legal Assistance Program (HELP) at Widener University on the project.
“This project takes two highly-successful models – Nurse-Family Partnership and Medical-Legal Partnership – and integrates them to create a broad based network of services.” said Theresa Brown, BSN, RN, a member of the Foundation’s review committee who is both a practicing nurse and a frequent contributor to the New York Times. “While medical-legal partnerships have existed in traditional hospital settings for years, this community-based effort represents a bold, new approach to addressing the social determinants of health."
In this new model, the NFP/MM staff of 40 public health nurses work on teams with lawyers from the HELP program to provide seamless health, legal and social services to more than 650 new mothers per year. The team addresses unmet legal needs, identifies and pursues policy issues affecting client health, and improves program efficiency by freeing up time previously spent by nurses on case management. Staff also measure cost savings and social return on investment to help the program secure ongoing funding, and provide a road map for statewide replication and expansion.
Integrating Nurse Practitioner-Led Clinics With Head Start Sites. Sharp Health Care Foundation; UTHSC Houston; UTHSC San Antonio (Principal Investigator: Julie C. Novak, DNSc, RN, CPNP, FAANP, FAAN) The Hillman Innovations in Care grant has helped to expand a new clinic model that provides integrated health services at local Head Start/Early Start sites. The project is a partnership with AVANCE-Texas, which provides early childhood education programs and services to families in at-risk communities, empowering children and their parents by providing them with the tools and resources they need to succeed in life. AVANCE and UTHSC-San Antonio developed the initial pilot clinic, led by a nurse practitioner, which has already provided services to over 300 children and has increased vaccination rates from 50% to 100%. Grant funding allowed the team to expand services to three additional sites, not just to the enrolled children but to their parents and siblings, more than tripling the number of children and families that are served. Clinic sites will also expand services to include nutrition counseling and mental and behavioral health. With all sites fully equipped to meet the health and psycho-social needs of the entire family, the team envisions that this model could be replicated throughout Texas and the nation.
Team-Based Home Care and Home Repair Services Help Older Adults Remain in their Communities. Grand Valley State University; Michigan State University (Principal Investigators: Sandra Spoelstra, PhD, RN, and Sarah Szanton, PhD, RN/ANP) Hillman funding is supporting the expansion of MiCAPABLE, which provides team-based home care and home repair services to help older adults remain in their homes and communities. The award-winning program was originally launched by Dr. Szanton at Johns Hopkins School of Nursing. MiCAPABLE was piloted at one site in Michigan, and is now implemented in four Michigan Medicaid Waiver sites, which provide services to help nursing home eligible older adults avoid nursing home admissions. Program participants receive 12 weeks of home visits from a team that includes a registered nurse and an occupational therapist, to ensure that health needs are met, and a handyman, to accommodate the home to the needs of an aging adult. The team’s work might include training to help avoid falls, and the installation of bathroom grab bars and other home modifications. Funding is used to train clinicians and provide MiCAPABLE to 270 patients. The State of Michigan is matching the Innovations in Care grant with an additional $600,000, allowing the team to leverage a total of $1.2 million in funding.