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. November 29, 2001 Rochester Health Care Forum www.rhealth.com 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

3. November 29, 2001 Rochester Health Care Forum www.rhealth.com 3 Palliative care Relieving suffering Improving quality of life

4. November 29, 2001 Rochester Health Care Forum www.rhealth.com 4 Hospice Palliative care Curative / remissive therapy Presentation Death

5. November 29, 2001 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

6. November 29, 2001 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

7. November 29, 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.

8. November 29, 2001 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.

9. November 29, 2001 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.

10. November 29, 2001 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

11. November 29, 2001 Rochester Health Care Forum www.rhealth.com 11 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

12. November 29, 2001 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

13. November 29, 2001 Rochester Health Care Forum www.rhealth.com 13 Vision of Rochester Health Care Forum Quality Cost Access to Services –Palliative Care Services –Hospice Services

14. November 29, 2001 Rochester Health Care Forum www.rhealth.com 14 Focus on Quality Long Range Goals Short Term Projects

15. November 29, 2001 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

16. November 29, 2001 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

17. November 29, 2001 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

18. November 29, 2001 Rochester Health Care Forum www.rhealth.com 18 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

19. November 29, 2001 Rochester Health Care Forum www.rhealth.com 19 Ensuring Excellence in End-of-Life/Palliative Care “Hope for the Best. Prepare for the Worst.”

20. November 29, 2001 Rochester Health Care Forum www.rhealth.com 20 Ensuring Excellence in End-of-Life/Palliative Care Questions?