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Onondaga County MOLST Quality Forum Update on MOLST Facility Implementation and Quality Improvement Audits January 200

Onondaga County MOLST Quality Forum Update on MOLST Facility Implementation and Quality Improvement Audits January 2008. Cheryl Morrow, M.D. Chief Medical Officer of CNY, Director of CNY Operations, Elder Medical Services P.C. Faculty Member, Education for Physicians on End-of-life Care

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Onondaga County MOLST Quality Forum Update on MOLST Facility Implementation and Quality Improvement Audits January 200

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  1. Onondaga County MOLST Quality ForumUpdate on MOLST Facility Implementation and Quality Improvement Audits January 2008 Cheryl Morrow, M.D. Chief Medical Officer of CNY, Director of CNY Operations, Elder Medical Services P.C. Faculty Member, Education for Physicians on End-of-life Care Member, Monroe and Onondaga Counties MOLST Implementation Team cbmorrow@ltcpractice.com Mark Buttiglieri, ACSW Director, Social Work/Continuum of Care, University Hospital Upstate Medical UniversityMember, Monroe and Onondaga Counties MOLST Implementation Team Buttiglm@upstate.edu FLGEC-UNY A nonprofit independent licensee of the BlueCross BlueShield Association

  2. Community Implementation: MOLST Facility Survey

  3. MOLST Facility Survey • Early phase: Facility education & training of EMS providers • March 2006: MOLST Facility Survey distributed to 115 facilities in Monroe and Onondaga Counties • Response rate of 98% (n=112) • Time required for implementation varied significantly across facilities, with less adult homes and assisted/enriched living programs planning on adoption of MOLST

  4. MOLST Facility Survey • 52 facilities (46%) implemented MOLST • Hospitals and nursing homes first to implement MOLST, followed by hospice programs, and program of all inclusive care of the elderly (PACE) • 76% of respondents had implemented or planning to implement MOLST

  5. Quality Improvement:MOLST QI Chart Review

  6. MOLST QI Chart Review • November 2006 – Facilities in Monroe & Onondaga Counties • Total of 905 medical records reviewed • Majority of chart reviews were completed for patients that died • Facility Participants: 4 Hospitals, 57 Nursing Homes, 2 PACE, 1 Hospice, 24 Enriched and Assisted Housing, 25 Adult Homes

  7. MOLST QI Chart Review • Repeat Facility QI Review 2007 • Preliminary results since December 2007 • Total of 381 medical records reviewed to date in this repeat survey • Participants: Hospital, NH, Pace, EHP • Comparisons to 2006 survey

  8. QI Target: DNR/CPR Consent • Patient/HCA Consent for DNR – 100% • Supplemental Documentation present 57% (113/198) for 2007 and 58% (227/389) for 2006

  9. Accuracy of Completion: DocumentationPatient or Health Care Agent Consent

  10. Full Code Documentation • Is MOLST being utilized to document full code status? • 7% MOLST document full code in 2006 • 16% MOLST document full code in 2007

  11. Accuracy of Completion: MOLST Signed by Physician

  12. Other Advance Directives • 2006: 62% Health Care Proxy (448/722) • 2007: 70% Health Care Proxy (238/338) • No advance directives marked 2006: 29% reported 2007: 21% reported

  13. Life-Sustaining Treatment • Other Treatment Directives • 2006 None Specified 48% • 2007 None Specified 33% • Comfort-oriented care only: when other instructions identified • 2006 8% • 2007 23%(majority in PACE and nursing home)

  14. Life-Sustaining Treatment Other Documented Treatment Guidelines: • Intubation and Ventilation Instructions • 2006 44% • 2007 55% (higher documentation hospital) • Artificial Hydration/Nutrition Directives • 2006 38% • 2007 52% (higher documentation in PACE)

  15. Future Hospitalizations Documented Treatment Guidelines: • Hospitalization and Transfer • 2006 13% • 2007 49% (higher documentation in PACE)

  16. 2008 QI Targets Identified • Review/Renew section of MOLST • Issues of capacity and consent(Supplemental form completion) • Additional treatment directives

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