Ensuring Excellence in End-of-Life/Palliative Care

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Ensuring Excellence in End-of-Life/Palliative
Care

• Rochester Health Care Forum
• Report to the Community
• 11/29/01
• Patricia A. Bomba M.D.
• Excellus Medical Director, Geriatrics

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Palliative care expanded definition

• Affirms life, regards dying as a normal process
• Neither hastens nor postpones death
• Provides relief from pain, other symptoms
• Integrates psychological and spiritual care
• Interdisciplinary team
• Support system for the family
• WHO 1990

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Palliative care

• Relieving suffering
• Improving quality of life

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Curative / remissive therapy
Presentation
Death
Hospice
Palliative care
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Continuum of Care

• Wellness Acute Chronic Palliative
  Hospice
• and ? Care ? Care ? Care ?
  Care
• Preventive and
• Services Long Term Care

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Background

• IOM Report Approaching Death Improving Care at
  the End of Life
• RIPA/BCBS EOL/Palliative Care Professional
  Advisory Committee
• Community-Wide End-of-Life Survey Report, January
  2001
• Rochester Health Care Forum Initiative, March 2001

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Report Recommendations

• Everyone should have a comprehensive Advance Care
  Directive.
• The health care community should adopt a
  comprehensive advance care directive that all
  area practitioners and institutions will honor.

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Report Recommendations

• Patients should be referred to Hospice earlier so
  that the social, spiritual, and psychological
  components of suffering can be addressed.
• Practitioners and Health Care Facilities should
  establish comprehensive pain assessment and
  treatment standards at every site of care.

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Report Recommendations

• Health Care Institutions should be encouraged to
  set performance goals and track basic statistics
  regarding end-of-life care.

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Organizational Structure

• Community-Wide Advisory Group
• Steering Committee charged with setting direction
  for, overseeing, and ensuring the implementation
  of a set of broad End-of-Life/Palliative Care
  projects

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Organizational Structure

• Workgroup 1 Exploring and communicating treatment
  wishes
• Workgroup 2 Ensuring patient wishes are
  identified and honored at all sites of care
• Workgroup 3 Relieving physical, psychological,
  spiritual symptoms and providing patient/family
  support
• Workgroup 4 Facilitating communication and
  education, both community and professional

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Participating Organizations Community
Representatives

• Insurers BCBSRA Preferred Care
• Hospital Systems Strong, Via, Unity
• Nursing Homes SHA, ROHM, Others
• Providers MDs, RNs, SWs
• Legal and Ethical
• Spiritual and Cultural
• Educators and Consumers
• Level Two
• Level Three
• Level Four
• Level Five

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Vision of Rochester Health Care Forum

• Quality
• Cost
• Access to Services
• Palliative Care Services
• Hospice Services

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Focus on Quality

• Long Range Goals
• Short Term Projects

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Short Term Projects

• Workgroup 1
• Community Conversations on Compassionate Care,
  2002
• Increase comfort level in discussing death and
  dying
• Broaden awareness of initiative and gain
  community input
• Focus discussion on conversations that will lead
  to completion of an Advance Care Directive

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Short Term Projects

• Workgroup 2
• Physician Orders for Life-Sustaining Treatment
  (POLST) or equivalent form
• promote patient autonomy
• enhance authorized transfer of information
• clarify treatment intentions
• Life Info Pak (Vial of Life)
• facilitate appropriate treatment by emergency
  personnel

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Short Term Projects

• Workgroup 3
• Principles of Pain Management
• Pain as a Fifth Vital Sign
• Identified as a Quality Initiative
• Opportunity to expand steering committee
• Expanded distribution
• Broad-based approach across the continuum of care
• Consumer input

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Short Term Projects

• Workgroup 4
• Community website and exploration of additional
  communication channels
• Professional Education for Physicians
  on End-of-Life Care (EPEC)
• Community Comprehensive Calendar
  Speakers Bureau

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Ensuring Excellence in End-of-Life/Palliative
Care

• Hope for the Best.
• Prepare for the Worst.

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Ensuring Excellence in End-of-Life/Palliative
Care

• Questions?