Demonstration Projects: Work with agencies such as the Departments of Health, Health Care Reform, Public Welfare, Aging, and the PA Health Care Cost Containment Council (PHC4), along with CMS to design and/or implement demonstration projects aimed at (1) improving quality at the end of life and (2) studying the effect of risk-adjusted payments to Medicare and Medicaid managed care plans for patients with life-limiting, eventually fatal chronic illnesses in an effort to encourage continuity across time and health-care delivery settings, including home-based care.

Documenting Treatment Preferences: Encourage the Department of Health, the state legislature, and accrediting bodies such as JCAHO and CHAP to adopt a standardized tool for documenting people's wishes, such as the POLST (Physician Orders for Life-Sustaining Treatment), to be used statewide and be transferable following patients to all care settings to improve quality of care across settings. Work to develop and implement a pilot for implementation in the region.

Engagement of Underserved Communities: Engage underserved communities, such as minorities and people with disabilities, in discussions and workshops that assess their needs and involve community members in setting priorities for improvement of end-of-life care.

Professional Education, Accreditation, and Licensing: Pursue the following strategies for improving palliative and end-of-life care education:

• Advocate for the utilization of existing structures and systems to ensure that health care professionals, who provide care in any setting, as well as those who regulate institutions, adopt and enforce standards for education. (e.g., State professional licensing boards should require that candidates demonstrate evidence of training in palliative care/core end-of-life domains; agencies that regulate long-term care facilities should require evidence of staff training in end-of-life care; state surveyors of long-term care facilities should receive necessary training in end-of-life care.)
• Work with accrediting bodies to require educational institutions to incorporate core palliative care educational domains in their curricula.
• Partner with professional organizations (e.g., American Medical Association and the National Association of Social Work) to design/sponsor train-the-trainer programs for faculty responsible for end-of-life instruction and continuing education in core end-of-life domains at local, regional, state meetings.

Public Awareness/Education Campaign: Work with various media outlets and private and public partners (i.e. the Governor's office and Departments of Health, Health Care Reform and Aging) to implement the regional arm of a statewide public awareness/education campaign. The intention of this campaign is to improve Pennsylvanians' access to palliative care and end-of-life services by helping them become more informed about palliative care and be proactive consumers of quality health care services. This campaign would be characterized by the following:

• Include a web-based statewide clearinghouse for Palliative Care for health care professionals and consumers.
• Be informed by the life situation and palliative care needs of a variety of groups and individuals including the elderly, people with disabilities, and children and their families.
• Involve individuals from the community such as hospice and palliative care educators, spokespersons, outreach workers, and liaisons.
• Encourage the Governor's office to mandate that the Departments of Health and Aging and other appropriate state agencies jointly prepare a "State of End-of-Life Care Report" every two years to describe ongoing state initiatives and to track changes over time.