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Ensuring Excellence in End-of-Life/Palliative Care

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. Palliative care – expanded definition. Affirms life, regards dying as a normal process

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Ensuring Excellence in End-of-Life/Palliative Care

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  1. 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

  2. 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 Rochester Health Care Forum www.rhealth.com

  3. Palliative care • Relieving suffering • Improving quality of life Rochester Health Care Forum www.rhealth.com

  4. Curative / remissive therapy Presentation Death Hospice Palliative care Rochester Health Care Forum www.rhealth.com

  5. Continuum of Care Wellness Acute Chronic Palliative Hospice and  Care  Care  Care  Care Preventive and Services Long Term Care Rochester Health Care Forum www.rhealth.com

  6. 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 Rochester Health Care Forum www.rhealth.com

  7. 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. Rochester Health Care Forum www.rhealth.com

  8. 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. Rochester Health Care Forum www.rhealth.com

  9. Report Recommendations • Health Care Institutions should be encouraged to set performance goals and track basic statistics regarding end-of-life care. Rochester Health Care Forum www.rhealth.com

  10. 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 Rochester Health Care Forum www.rhealth.com

  11. Organizational Structure • Workgroup 1Exploring and communicating treatment wishes • Workgroup 2Ensuring patient wishes are identified and honored at all sites of care • Workgroup 3Relieving physical, psychological, spiritual symptoms and providing patient/family support • Workgroup 4Facilitating communication and education, both community and professional Rochester Health Care Forum www.rhealth.com

  12. Participating Organizations & Community Representatives • Insurers: BCBSRA & Preferred Care • Hospital Systems: Strong, Via, Unity • Nursing Homes: SHA, ROHM, Others • Providers: MD’s, RN’s, SW’s • Legal and Ethical • Spiritual and Cultural • Educators and Consumers • Level Two • Level Three • Level Four • Level Five Rochester Health Care Forum www.rhealth.com

  13. Vision of Rochester Health Care Forum • Quality • Cost • Access to Services • Palliative Care Services • Hospice Services Rochester Health Care Forum www.rhealth.com

  14. Focus on Quality • Long Range Goals • Short Term Projects Rochester Health Care Forum www.rhealth.com

  15. 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 Rochester Health Care Forum www.rhealth.com

  16. 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 Rochester Health Care Forum www.rhealth.com

  17. 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 Rochester Health Care Forum www.rhealth.com

  18. Short Term Projects • Workgroup 4 • Community websiteand exploration of additional communication channels • Professional: Education for Physicians on End-of-Life Care (EPEC) • Community: Comprehensive Calendar Speakers Bureau Rochester Health Care Forum www.rhealth.com

  19. Ensuring Excellence in End-of-Life/Palliative Care “Hope for the Best. Prepare for the Worst.” Rochester Health Care Forum www.rhealth.com

  20. Ensuring Excellence in End-of-Life/Palliative Care Questions? Rochester Health Care Forum www.rhealth.com

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