Quality Improvement Group to Address End-of-Life Care Planning on Long Island

IPRO, leader of improving network quality Atlantic (Aqin) based in New York, received special funding from the Centers for Medicare and Medicaid (CMS) for the "end of life Transformation Initiative," a two-year project to help inform Medicare beneficiaries and health professionals in the counties of Nassau and Suffolk in the preparation of the end of life.

The project will focus on the requirements of the State of New York for treatment Survival Initiative (MOLST), which aims to improve the quality of care received by people at the end of their lives by meeting their preferences, values ​​and beliefs -Make informed through a shared decision communication with their families and health professionals process.

"In its 2014 report, dying in America, Institute of Medicine (IOM) has identified the need for public participation and education planning for end of life," said the Director General of Health IPRO Clare Bradley, MD , MPH. "The report also found that it is important to encourage meaningful conversations with family members, caregivers and health professionals. We hope to have an impact in these two areas."

IPRO will partner on this project with Patricia Bomba, MD, FACP, vice president of the BlueCross BlueShield Excellus in geriatric care nationally recognized palliative, and an expert on elder abuse in later life. Dr. Bomba heads the implementation team MOLST statewide and national health decisions Day New York State Coalition serves eMOLST program manager and served on the committee that drafted the IOM report in 2014 cited above. Working with the Department of State of New York Health, Dr. Bomba helped establish MOLST as a statewide program. She passionately supported the mission of making the state a leader in promoting a lively discussion on planning for the end of life and to ensure excellence in the final delivery / palliative of life, service all segments of the community during almost two decades.

"People can take control of their quality of life at the end of life," says Dr. Bomba. "They have to choose how they want to live the end of their lives, their confidence to make decisions if you become unable to do so and have a conversation with their loved ones. Physicians should help initiate conversations with their patients about this type making. "

IPRO will partner with organizations in Suffolk and Nassau counties to conduct awareness and provide training sessions for seniors, their families and caregivers to help them understand how to communicate with health professionals, the better the end of life informed medical decisions, and ensure that your end of life wishes are carried out correctly.

"Patients want time with their doctors to discuss end of life, and doctors should be trained for such discussions, so they can provide care consistent with the values ​​and preferences of patients end their quality of life," he says Dr. Bomba.

As of January 1, 2016 CMS began reimbursing physicians and other health professionals trained to have end of life discussions with their patients.

The project will focus on eMOLST a secure web-based application that helps health professionals in documenting the MOLST debates, including values, beliefs and goals for patient care and helps ensure patient access to medical orders and MOLST discussion. IPRO provide technical support to providers of health care throughout the duration of the project, to facilitate the adoption, training and implementation of eMOLST.

"New York EMOLST easy to use, and improves clinical outcomes legal, community and offers a solution to ensure the prescription and a copy of the discussion are available in an emergency," says Dr. Bomba.

Long Island was chosen for the efforts focused on planning end of life care focused on IPRO review and analysis of data from 2012 Dartmouth Atlas of Health Care. For more than 20 years, Atlas has documented changes in how medical resources are distributed and used in the United States. The Dartmouth Atlas used Medicare claims data for analysis of national, regional and local markets and health care hospitals and affiliated physicians.

In the Medicare population in the state, Dartmouth Atlas data show that in 2012 the referral hospital Long Island Region (FCR) ranked highest of all hospital admissions in New York State HRRs during the last six months. FCR Long Island the percentage of patients who happened also ranks in the top three for HRRs days of hospitalization in the last six months, income in the ICU / CCU during hospital stays in which the patient died, and seven days or more than one ICU / CCU in the last six months.

"There is a big break in Long Island to develop a Community approach to advance care planning to help Medicare beneficiaries receive quality care end of life that is aligned with their values, beliefs and goals for care "says Dr. Bradley.