Compassion and Support
FEBRUARY 2016
National POLST Paradigm: The Next Phase

After nearly a year of study, consensus was achieved that the National POLST Paradigm Office become an independent, 501(c)(3) nonprofit organization headquartered in Washington, DC.

Background
The National POLST Paradigm Office and Task Force were initially created in 2004; almost from its inception the National POLST Paradigm Office has been housed, funded and supported at OHSU in the Center for Ethics. Executive leadership has grown from the early days of a part-time (4 hours a week) paid executive director. As of January 1, 2016, Amy Vandenbroucke, JD serves as the Executive Director of the National POLST Paradigm full-time, supported by administrative staff.

With growth comes the need to reevaluate structures that worked in the past and understand what will serve the National POLST Paradigm well going forward. The National POLST Paradigm Task Force identified a Core Group of six members to develop a business strategy to create a sustainable National POLST Paradigm Office and to help evaluate the Task Force’s current leadership structure.

Environmental Assessment
Based on their interviews with internal and external stakeholders, Solid Ground Consulting provided the Core Group with background to develop the business strategy. Clearly, several factors and trends have come together to create a “perfect storm” of opportunity on both the supply and demand side of the advance care planning equation.

The POLST Paradigm is widely seen as a best practice that developed through a process of consensus. The number of state POLST Paradigm Programs has greatly increased. The National POLST Paradigm Office plays a key role in advancing the POLST Paradigm. The vast majority of stakeholders laud national stewardship of the POLST Paradigm and underscore how important it is to establish and promote best practices for effective implementation.

Volunteer and professional leaders of the organization are widely respected for their expertise, skills, accomplishments, and commitment. However, capacity limitations at both the national and state level constrain efforts on multiple fronts. The current funding model is not sustainable.

Strategic Business Plan
The Core Group worked with Solid Ground Consulting to develop the business strategy, vision, mission and goals that were refined and finalized by the National POLST Paradigm Task Force. Work is underway to develop the governance structure, work plan and timelines for the transition. For more details, see State Overview National POLST Paradigm

Featured Resource: Recorded Webinar & Slides on New CPT Codes for ACP

New CPT codes have been established for advance care planning & end-of-life/MOLST discussions with patients & families. Excellus BlueCross BlueShield hosted a webinar on February 2, 2016 that covered the required elements of these conversations and how to bill for them. The webinar was recorded and posted to CompassionAndSupport's YouTube channel. It can be viewed here. Corresponding slides can be downloaded here.

MOLST FAQ: What's the Difference Between MOLST, POLST & POLST Paradigm?

National POLST Paradigm: process of communication & shared decision making results in POLST; has established endorsement requirements

POLST: Physician Orders for Life Sustaining Treatment - different states use different names to describe the state POLST program: such as MOLST, POST, LaPOST, MOST

MOLST: New York State’s Endorsed POLST paradigm program


eMOLST Champion: Kaleida

Kaleida Health, the largest healthcare provider in Western New York, serves an eight-county region surrounding Buffalo. Under the leadership of Elaine David, LMSW, corporate social work liaison, and Reverend Father Richard Augustyn, MDiv, MA, director of pastoral care, Kaleida was the first health system in WNY to begin using MOLST in 2005. Kaleida is now also the first health system in WNY to use eMOLST. Kaleida’s system leadership included eMOLST implementation as a key item in the value-based performance improvement program with Univera Healthcare for 2016.

Elaine and Father Richard spearheaded the eMOLST project on behalf of Kaleida’s Ethics Committee and developed a robust project team that includes representatives from all areas of the health system. Del Danvir, systems analyst, serves as the project manager. This project team’s strength and dedication have accelerated eMOLST implementation.

Kaleida’s eMOLST project team has been meeting weekly since October 2015. The team identified workflow improvements for advance care planning in general, and integrated eMOLST specifically. On February 1, 2016, LIVE access to eMOLST was made available to Kaleida users in the Buffalo General Medical Center ICU, the first site to use the application.

Father Richard stated, “At Kaleida, we believe using eMOLST is best practice to ensure patients’ end-of-life goals and medical orders are available across all care settings.” Elaine shared, “Kaleida is committed to eMOLST implementation throughout our health system. We are proud to be a leader in WNY and an example for health systems across NYS.”

The project team recognized a significant need for additional provider education on the MOLST process. To meet this community need, Kaleida and Univera are co-sponsoring a MOLST & eMOLST community education day on October 5, 2016 which is open to all providers from WNY.

Pew Trust POLST Paradigm Toolkit

The National POLST Conference held in Chicago on February 3-5 was well received by attendees from across the nation. Dr. Martha Twaddle delivered the keynote address on “The Future of POLST: Challenges and Opportunities.” Speakers presented on the latest research, the national digital communication strategy and the new business strategy. Attendees were passionate and focused. The conference provided for small group interactive sessions on an array of pertinent topics needed to ensure implementation of a POLST Paradigm program consistent with national standards.

Among the many sessions presented at the conference were five breakout sessions devoted to helping build a POLST Paradigm Toolkit, with support from a grant from Pew Trust. Attendees shared what they would find useful in specific sections of the toolkit and brainstormed ideas. If you have found specific NY MOLST tools and resources particularly helpful or recognize gaps, please email me at patricia.bomba@lifethc.com.

The main goal of the project is to increase implementation among health care facilities. The toolkit will address the needs of specific patient populations and providers in different health care facilities to show how the POLST Paradigm can be used to support patients through care transitions. Additionally, the toolkit will help educate clinicians and health care facilities about the benefits of the POLST Paradigm.

There will be three sections of the toolkit that will provide setting-specific resources for POLST implementation to address the specific needs to implement POLST in different types of care settings. Each section will be able to stand independently but will be presented as a single document:

1. Primary Care Physician Practices (including rural areas)
2. Hospitals and Trauma Settings (EMS, EDs)
3. Long Term Care Facilities (nursing homes, ALFs, hospice)

Each section will include, but not be limited to:

a. Frequently asked questions
b. POLST best practices, including sample policies, procedures or elements that should be included in the policies and procedures for that clinical setting
c. Guidelines on how to have POLST conversations with the patient population served in that clinical care setting and who should be leading those conversations; and
d. Advice on introducing the concept

The toolkit is expected to be done by the end of 2016. Dissemination will include webinars and presentations at national conferences.

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