About
Project Descriptions
Health Care System Work Group
David Kaufman MD, Chair
Board members D. Kaufman MD, St. Vincent Hospital; Chris McCluskey RN, and H. Brownell Wheeler MD; and Mary K. Alexander RN Ed.D., Prof. Emeritus UMass Graduate School of Nursing (GSON); Edward Amaral MD, Fallon Clinic; Jean Boucher RN, Ph.D., UMass GSON; Diane Burke RN, Worcester District Medical Society (WDMS) Alliance; Joyce Cariglia, WDMS; Flo Leclair RN, UMass Memorial Health Care (UMMHC) Hospice; Bernadette Meade DO, Fallon Clinic; Pamela Miner MD, Department of Veteran Affairs; Ann Marie Sciammacco RN, Fallon Community Health Plan; Leo Stolbach MD, consultant, St. Vincent Hospital (retired); Mary Valliere MD, UMMHC; Mary Whalen RN, VNA Care Hospice; Valerie Wedge, MSW, UMass Medical School
Seek and Maintain Support
from Healthcare Leaders
Accomplished: Meetings have been held with the CEOs of UMass Memorial Healthcare System (UMMHS), St. Vincent Hospital (SVH), the Fallon Clinic (FC) and the Fallon Community Health Plan (FCHP). They have expressed their support and followed through in practical ways to improve palliative care in their organization. Each of these organizations and also UMMS and VNA Care Network are represented on the Partnership board of directors and have agree to provide financial support after the publicly-supported three-year implementation period ends in June 2006.
Improve Palliative Care in Acute Care Hospitals
Sub-group membership: D. Kaufman, M.Valliere, H. B. Wheeler
Accomplished: At UMMHS, a palliative care consult service was instituted in October 2003 and St. Vincent Hospital is instituting palliative care services within the institution.
Improve Palliative Care in the Community
Accomplished: In collaboration with the Partnership, the VNA Care Network, the Fallon Community Health Plan, and St. Vincent Hospital are beginning a pilot program to improve palliative care in COPD patients.
Planned: This project will likely be expanded to other disease categories with time, for example CHF.
Improve End of Life Care in Extended Care Facilities
M. K. Alexander, Co-Chair; Sarah McGee MD, UMMS/Notre Dame Long Term Care Center, Co-Chair
Sub-group membership: Alice Bonner RN, Fallon Clinic; Sr. Pat Foley RN, UMMHC Hospice; Pat Kennedy RN, VNA Care Hospice; Carlyn Lussier RN, Notre Dame Long Term Care Center; B. Meade; C.McCluskey; Janet Mullen RN, UMMHC Hospice; Matt Salmon, Beaumont at Northbridge; Sheila Trugman MD, Jewish Health Care Center; Martina Salek RN, Jewish Health Care Center; Linda Satkowski RN, Evercare; Mary Whalen RN, VNA Care Hospice
Accomplished: In 2003 focus groups were held with directors of nursing homes and assisted living facilities (in collaboration with the Massachusetts Compassionate Care Coalition). Common end-of-life problems were identified and nursing home directors expressed a sincere interest in collaborating to correct them. An Extended Care Facility Sub-Group was then formed to initiate projects to improve end-of-life care in nursing facilities. The group has sponsored 2 educational seminars concerning end of life care for nursing home staff in 2004. The first program was provided through support from RWJF Rallying Points Certificate Program, the second in partnership with the Massachusetts Pain Initiative. Several sub-group members are working with the Center for Health Policy and Research to identify outcome measures for end-of-life care for nursing home residents.
Planned: The project is continuing in 2005 with planning for additional projects to address a variety of end of life issues in the nursing home.
Improve End of Life Care in Emergency Settings
Sub-group chair: D. Kaufman
Accomplished: Problems have been identified due to differing organizational policies regarding DNR orders. Orders at one institution are not honored when patients are transferred to a different facility. A new DNR/CMO policy suitable for system-wide adoption has been drafted. As a concept, it has been received with enthusiasm. SVH has formally approved the protocol, and has received preliminary committee approval at UMMHC as well. Encouraging meetings have been held with Emergency Medical Services and Fire Department emergency personnel.
Planned: Conversations have been initiated with the End of Life Commission and the Mass Health Data Consortium regarding expanding the program to a statewide basis.
Improve Hospice Utilization
Sub-group membership: L. Stolbach, J. Boucher, F. Leclair, M. Whalen
Accomplished: A pilot survey was carried out to identify the main deterrents to hospice referrals. Based on preliminary results, the survey was revised and then circulated to 720 physicians, in collaboration with the Worcester District Medical Society. The intent is to identify and address the principal obstacles among physicians to hospice referrals, in order to promote earlier and more widespread use of hospice services.
Planned: Based on survey findings, interventions will address the factors identified as barriers to timely referrals.
Collaborate on Educational Programs
on End-of-Life Care
Accomplished: In March 2003 a CME/CEU educational program on end of life care for healthcare providers was attended by nearly 200 participants. The spring issue of Worcester Medicine was devoted to end-of- life care with articles from members of the Health Care Work Group.
Promote Advance Care Planning
via A Guide for a Better Ending
Accomplished: The Health Care Work Group reviewed and approved the advance care planning brochure, Guide for a Better Ending, and healthcare proxy form. Members of the Work Group are starting to work with healthcare providers to promote their utilization of the Guide. The fall issue of Worcester Medicine had the Guide for a Better Ending inserted into 3000 copies, with a letter of explanation urging physicians to provide these forms to their patients and to encourage their use. A Speaker’s Bureau has been formed and trained.
Planned: UMMC, St. Vincent Hospital and FCHP are committed to developing a systematic plan for ensuring distribution and use of the Guide, and will review progress at HCWG meetings. It is expected that Fallon Clinic and VNA Care Network will do likewise.
Ensure Access to Advance Directives
in Health Care Facilities
Sub-group membership: D. Burke, Jonathan Harding MD, J. Cariglia, P. Miner
Accomplished: The Work Group is asking health care institutions to examine their procedures for assuring that advance directives are filed appropriately and made available when needed. Focus groups have been held with clinical and administrative staffs at St. Vincent Hospital and UMMC.
Maintain Liaison with MCCC and
EOL Commission on State Policy Issues
Sub-group membership: H.B. Wheeler, D. Kaufman
Accomplished: ability for statewide planning regarding EOL care rests with the legislature’s End-of-Life Commission and the Massachusetts Compassionate Care Coalition. CMP will provide input and assist in developing statewide policy in collaboration with these groups. Issues identified by our regional Partnership as deserving study include: clarifying and simplifying the protocols for Comfort Care and DNR orders, making needed modifications in state policy regarding pain medications, reviewing state reimbursement policies and practices to ensure that transition to palliative care or hospice is not penalized, investigating the use of electronic storage systems for ready online access to advance care planning documents, and collaboration with Senator Moore’s initiative on a long-range healthcare strategy for the state that includes a section on end-of-life care.
Planned: Still another issue to be considered is the fact that fear of malpractice litigation may sometimes stand in the way of optimum end-of-life treatment.
Identify Outcome Measures to Describe
the End of Life Experience in Central MA
Accomplished: This initiative is to create a baseline quantitative snapshot that describes the experience of dying patients and their care through existing databases, survey materials and/or interviews with surviving family members. Initial discussions in the work group were held to determine measurable outcomes for end of life care in different settings and to identify existing resources that capture these data. Medical students were hired to do a survey, which has been completed. A good initial response has been achieved with 250 returns out of 900 mailed, and a second mailing is in progress to strengthen the response rate. Preliminary data analyses are underway.
Planned: Complete the analysis, formulate conclusions and recommendations, and carry out interventions based on the results of the study.
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