SC Coalition for the Care of the Seriously Ill ( SC CSI)

August 27, 2011

SCMA Board Retreat

John C. Ropp, III, MD, Chairman, SC CSI

Outline•Overview SC CSI •Membership, Mission, Aims, and Activities•‘Mainstreaming’ Palliative Care •Consider legislative strategy for 2012 (POLST)•Feedback from SCMA Board •October 12 Summit on Care of the Seriously Ill

SC Coalition for the Care of the Seriously Ill ( SC CSI)

•Founding Members: SCMA, SCHA, TCC, SC Healthcare Ethics Network, LifePoint, AARP, SC Nurses Association

•Mission: All persons in SC with serious, chronic, or terminal illnesses will have an active voice in the care decision process

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• Almost 50% of U.S. population has at least one chronic medical condition, consuming 80% of healthcare resources

– Hypertension is the most common chronic condition, with 50M+ people in the U.S. needing treatment for high blood pressure

– 23M people have asthma, with economic costs projected at $20B in 2010

– 24M people have diabetes; one-fourth are unaware they have it

• Between 2005 and 2030, the number of Americans with chronic conditions will increaseby almost 30%

– 20% to 30% of all Americans are projected to have diabetes by 2050

Sources: Partnership for Solutions, John Hopkins University; Health Affairs, 26, no. 1 (2007): 142-153

Large and Growing Problem: People with Chronic Medical Conditions

118

125

133

141

149

157

164

171

100

120

140

160

180

1995 2000 2005 2010 2015 2020 2025 2030

Number of People With Chronic Medical Conditions (in millions)

5+ chronic

conditions

66%

No chronic

conditions

1%

4 chronic

conditions

13%

1-2 chronic

conditions

10%

3 chronic

conditions

10%

Source: G. Anderson and J. Horvath, Chronic Conditions: Making the Case for Ongoing Care. Baltimore, MD: Partnership for Solutions, December 2002.

Medicare Beneficiaries - Chronic Conditions & Spending

Cancer vs. Non-Cancer IllnessTrajectories to Death

Cancer vs. Non-Cancer IllnessTrajectories to Death

Hea

lth S

tatu

s

Time

Crises

Death

Decline

Field & Cassel, 1997Field & Cassel, 1997

Cancer

End-organ disease

30 MONTHS

4 Aims 1. Education/tools for healthcare professionals

• Toolkit with sample policies developed by physicians: C-ROS; Communication, Consent, Decision-making Process for Seriously Ill Inpatients

• Improve communication as patients transition across the continuum of care

• Identification of patient values, beliefs, and wishes regarding their own healthcare

• Best practices for honoring advance directives regardless of setting

4 Aims

2. Education/tools for patients and communities•Advance Directives•Healthcare decision making • Understanding their diagnosis and what they can do

3. Appropriate relationship-centered care in all settings

•Establish palliative care in all SC hospitals; expand palliative care training•County-level mapping of resources for chronic, serious, terminal illnesses and make information accessible

4 Aims4. Policy/Advocacy-Legal & RegulatoryAdvocate for the alignment of requirements and policies related to the care and decision-making processes for the care of seriously, chronically, or terminally ill persons

• Consider feasibility of ‘durable DNR orders’• Consider POLST for SC (Physician Orders for Life-Sustaining Treatment Paradigm)

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‘Mainstreaming’ Palliative CareDefinition of Palliative Care: Interdisciplinary care that aims to relievesuffering and improve quality of life forpatients with advanced illness, and their families.It is provided simultaneously with allother appropriate medical treatment.

www.capc.org

Palliative care means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice.

73 FR 32204 - Medicare Hospice Conditions of Participation –Final RuleJune 5, 2008

Palliative Care•Primary palliative care: refers to the basic skills and competencies required of all physicians and other health care professionals.

•Secondary palliative care: refers to specialist clinicians that provide consultation and specialty care.

POLST: Physician Orders for Life-Sustaining Treatment Paradigm

The national POLST Paradigm program is designed to improve the quality of care people receive at the end of life. It is based on “effective communication of patient wishes, documentation of medical orders and a promise by health care professionals to honor these wishes. “

When is POLST Appropriate?

• Terminal illness• Advanced disease• Prognoses is death

within a year• Debilitating chronic

progressive illness

In the Emergency Department

• “Why is this patient here?”• “What does this patient want?”• “How aggressive should we be?”• “Do I intubate the patient?”• “Who is involved in this patient’s care?”• “Who has authority to speak for this patient?”• “What is the appropriate disposition?”

Developing ProgramsDeveloping Programs*As of January 2011

Endorsed ProgramsEndorsed Programs

No Program (Contacts)No Program (Contacts)Designation of POLST Paradigm Program status based on information available by the program to the Task Force.

National POLST Paradigm Programs*

POLST History• 1991 - Patient Self Determination Act• 1991 - POLST form developed in Oregon• 2002 - POST in West Virginia• 2007 - MOST in North Carolina• 2011-Chairperson of SC CSI becomes POLST

contact for SC

How Advance Directives and POLST Work TogetherAdapted with permission from California POLST Education Program © January 2010 Coalition for Compassionate Care of California

An outcomes continuum: POLST

Better informed consent +

Patient’s documented wishes +

Family consensus

Patients’ wishes known & honored =

+Portable MD orders =

Satisfaction & communication

Risk & Costs=

= Hospice LOS = Hospital

LOS = Pain management

= Hospice & Palliative Care Utilization

POLST: Steps in the process

Needs assessmentCore working groupTask Force with reps

from all stakeholdersPilot ProjectLegal IssuesEducation/Training

Program CoordinationDistribution of formReview Program

Components and apply for endorsement

MediaAvailable Resources

POLST: Making it happen

• Legislation• Policy• Procedure• Protocol• Algorithm

• Education• Application• Process

Improvement• Data Collection

POLST ISSUES FOR SC•Access to POLST forms (24/7 access to a registry would be ideal)•Legislation needed if POLST to be used as a physician order•Messaging important—honoring patient wishes not cost containment•Roper to start demonstration project next month

Discussion/feedback

Reminder: Join us on October 12 in the SCMA Board Room for the Summit on the Care of the Seriously Ill