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ChallengingEmotions, ethicsControversiale.g.
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1. Physician Order for Life Sustaining Treatment: Developing a POLST Registry Jeff Duncan
Utah Department of Health
2. Challenging
Emotions, ethics
Controversial
e.g. Death Panels
Personal
Increasingly Essential
Driven by our success at treating chronic diseases
Without good advice, everything in the system leads people to the most expensive and often inhuman pathway of care.
Michael Leavitt, former HHS Secretary
Modern Healthcare article, March 21, 2011 End-of-life care decisions
3. A Physician Order placed in a patients chart
POLST allows individuals or surrogates to record specific preferences about life-sustaining care
Orders are transferrable from setting to setting
POLST is not an advance directive or living will
(National Quality Forum, 2006. A National Framework and Preferred Practices for Palliative and Hospice Care Quality: A Consensus Report)
Physician Order for Life Sustaining Treatment (POLST)
5. The POLST form
6. The POLST form
7. Implemented through Health Facility Licensing, UDOH in 2003
Became statute as part of Advance Health Care Directive Act of 2007 (Utah Code §75-2a-106)
> 26,000 forms in circulation, with 2/3 in community settings POLST in Utah
8. Among POLST forms in Oregon nursing facilities:
88% of forms reflected a DNR order
89% of forms limit medical care
Among those choosing DNR, 77% chose more than the lowest amount of care in at least one other category
Among those choosing full code, 47% chose less than the maximum amount of care in at least one other category
Hickman, S. E., Tolle, S. W., Brummel-Smith, K., & Carley, M. M. (2004). Use of the Physician Orders for Life-Sustaining Treatment Program in Oregon nursing facilities: Beyond resuscitation status. Journal of the American Geriatrics Society, 52, 1424-1429.
POLST research: Nursing facility residents
9.
Nearly one third of all Medicare spending occurs in the last 30 days of life. --Leavitt Article
If 10% of 26,000 patients with POLST in Utah receive life-sustaining treatment at average cost of $5000, then potential savings is $13 million per year Potential cost savings
10. Benefits of electronic POLST Registry Paper forms:
Get lost
When updated, they DONT get lost (newer orders confused with older ones
Immediate access to patients wishes for end-of-life care
Internet access, mobile devices
May help track wishes of unbefriended elderly
Research
11. Utah is a Beacon Community
Funded by ARRA
Goal is to improve health through health information exchange (HIE)
Beacon grant included funding to develop an ePOLST registry in Vital Records
Experience operating registries
Experience implementing IT systems
Same physicians do death certificates and POLST
Utahs ePOLST Registry
12. Steering Committee
Vital Records, EMS, physicians, attorneys
Contextual InterviewsIn progress
Nursing Home
Assisted Living
Hospice
Hospital
EMS
System RequirementsSummer 2011
DevelopmentSummer 2011
Pilot TestingFall, 2011
Developing an ePOLST Registry
13.
Jeff Duncan
Informatics Project Manager
Utah Department of Health
jduncan@utah.gov Questions?