Physician Order for Life Sustaining Treatment: Developing a POLST Registry

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 patient�s 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 DON�T get lost (newer orders confused with older ones Immediate access to patient�s 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 Utah�s ePOLST Registry

12. Steering Committee Vital Records, EMS, physicians, attorneys Contextual Interviews�In progress Nursing Home Assisted Living Hospice Hospital EMS System Requirements�Summer 2011 Development�Summer 2011 Pilot Testing�Fall, 2011 Developing an ePOLST Registry

13. Jeff Duncan Informatics Project Manager Utah Department of Health jduncan@utah.gov Questions?