Presentation to Quality and Safety Committee of QCC on MA Expert Panel on End of Life Care September

1
Presentation to Quality and Safety Committee
(of QCC)on MA Expert Panel on End of Life
CareSeptember 2, 2009

• Dominique Kim, MPH
• Vice-Chair- MA Expert Panel on End of Life Care
• Partners Health Care System

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Agenda

• Charge
• Progress toward achieving Council Goals
• Supportive Data for quality improvement or policy
  change
• Big challenges for Expert Panel in coming year

Dominique Kim, MPH
MA
Expert Panel on End of Life Care,
Sep. 2,
2009
3
ChargeChapter 305- Section 41

• SECTION 41. Notwithstanding any general or
  special law to the contrary, the executive office
  of health and human services, in consultation
  with the health care quality and cost council,
  commission on end-of-life care established by
  section 480 of chapter 159 of the Acts of 2000,
  and the Betsy Lehman Center for Patient Safety
  and the Reduction of Medical Errors, shall
  convene an expert panel on end-of life care for
  patients with serious chronic illnesses. The
  panel shall investigate and study health care
  delivery for these patients and the variations in
  delivery of such care among health care providers
  in the Commonwealth. For the purposes of this
  investigation and study, health care providers
  shall mean facilities and health care
  professionals licensed to provide acute inpatient
  hospital care, outpatient services, skilled
  nursing, rehabilitation and long-term hospital
  care, home health care and hospice services. The
  panel shall identify best practices for
  end-of-life care, including those that minimize
  disparities in care delivery and variations in
  practice or spending among geographic regions and
  hospitals, and shall present recommendations for
  any legislative, regulatory, or other policy
  changes necessary to implement its
  recommendations.

Dominique Kim, MPH
MA
Expert Panel on End of Life Care,
Sep. 2,
2009
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Progress toward Council Goals

• With respect to meeting its charge- Chapter 305
  Sec. 41, the Panel is on target to release
  recommendations to the Commonwealth by Oct. 31,
  the designated 6 month timeframe from the Panel's
  start-date.
• A closer look below.
• Conceptual Framework
• Steps taken
• Communication strategy

Dominique Kim, MPH
MA
Expert Panel on End of Life Care,
Sep. 2,
2009
5
Progress - Conceptual Framework

Patient Family Centered Engagement
Multicultural/racial disparities
Education of staff, patients, families, consumers
Variation in Resource Use
3 WORKGROUPS
Based on NPP Priority for
Palliative EOL Care (in blue)
Special populations
Evidence
Coordination/ Transitions in Care
Transparency Accountability
Pain and Symptom Management
Psychological and Spiritual Support
Final Recs Best Practices Public
Policy Regulation Legislation
1) Workforce for Palliative and Hospice Care
There will be sufficient clinical providers and
training programs to allow access to quality
palliative and end of life care for diverse
populations across the continuum of care
Workgroups create recs meeting criteria
Achievable Actionable Measurable
Equitable Cost-Effective
2) Communication between patient/family and
providers about treatment options All pts with
life-limiting illness will receive effective
communication from health care professionals
about their options for treatment, realistic info
about their prognosis, timely, clear, and honest
answers to their questions, advance directives,
and a commitment not to abandon them regardless
of their choices over the course of their
illness.
Each workgroup considers overarching themes above
focus areas below to form recs.
3) Access to Hospice and Palliative Care All pts
with life-limiting illness will receive
patient-centered, high quality palliative care
and hospice services.
Timeline for implementation
Workforce and Reimbursement
Data to accomplish goals
Communication and public engagement
Emerging evidence Initiatives models underway
Special populations
Provider Site specific efforts and clinical
leadership engagement
Dominique Kim, MPH
MA
Expert Panel on End of Life Care,
Sep. 2,
2009
6
Progress- Steps taken

• Panel has meet 3 times with additional meetings
  with Co-chairs.  
• A framework for developing the EOL recs was
  developed by the second meeting based on the
  NQF/NPP National guidelines for palliative and
  hospice care..
• The Panel was divided into 3 workgroups to
  address access, communications, and palliative
  care workforce shortage.
• The workgroups have met routinely during and
  between Panel meetings and completed a first daft
  of recommendations.

Dominique Kim, MPH
MA
Expert Panel on End of Life Care,
Sep. 2,
2009
7
Progress- Steps taken...

• A Core group of the Panel, including the
  Chair/Vice-Chairs, provides guidance for the
  workgroups to develop recommendations (e.g.
  national policy framework, synopses and
  presentations of data on the state of palliative
  and hospice care in MA, variation in EOL
  care/hospice, national benchmarks, and a working
  website).
• 2-3 Core members sit on each workgroups.
• Panel workgroups incorporate sisters initiative
  in MA to improve EOL care and education, such as
  the national NHDD and Chapter 305, sections 42
  and 43. (Later slides)

Dominique Kim, MPH
MA
Expert Panel on End of Life Care,
Sep. 2,
2009
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Progress- Communication Strategy

• Purpose
• To disseminate the recommendations and engaging
  ongoing input and support from stakeholders/the
  public
• Development- During developmental stage, seeking
  input on recommendations from stakeholders who
  impact or will be impacted by EOL care in MA, to
  test achievability.
• Post-release (Oct. 31)- Stakeholders- Will enlist
  ongoing input and engagement in months following
  report release, to clarify and support ongoing
  role of stakeholders in implementation.
• Post-release (Oct. 31)- Public/Communities- Will
  also ensure communication for public reaction to
  the report and to address opportunities for to
  engage in their implementation.

Dominique Kim, MPH
MA
Expert Panel on End of Life Care,
Sep. 2,
2009
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Some ways the Expert Panel is promoting the
Councils other EOL Goals

• Recommendations- Communications Workgroup
  (calling for endorsement)
• Recommendations- Communications Workgroup
• Recommendations- Access Workgroup
• Recommendations- ALL Workgroups

• Statewide public education campaign
• POLST (MOLST)
• Formal hospice and palliative care programs
• Policies and standards

In forming the recommendations Expert Panel
members are considering the needs and
expectations of multi-cultural groups, as well as
of disabled and other special interest
populations.
Dominique Kim, MPH
MA
Expert Panel on End of Life Care,
Sep. 2,
2009
10
Supporting Data

• Baseline
• To inform its work, the Panel members have
  studied data on
• Public attitudes toward and use of end of life
  care in MA (e.g. 2005 AARP/MA EOL Commission
  Data)
• Variation in hospital service use patterns
  (Dartmouth Atlas)
• Hospice care models such as by Hospice of the
  North Shore
• Potential for advance care planning tools such as
  POLST/MOLST.
• National best practices for programs that improve
  access and quality of end of life care.
• (Data and reports available upon request.)
• Future
• The final report will address concrete quality
  metrics and strategies for monitoring and
  improving end of life care, tied to structure,
  processes, and outcomes.

Dominique Kim, MPH
MA
Expert Panel on End of Life Care,
Sep. 2,
2009
11
Challenges and Some Steps to Address Them

• Learning then incorporating the plethora of
  national best practices into the recommendations
  to the extent possible .
• 2. Supporting community stakeholders in
  implementing and supporting the recommendations
  Stakeholders Health care systems, hospice and
  home care providers, caregiver groups, senior
  associations, etc.
• Expert Panel enlisting input on perceived
  feasibility among stakeholder groups given their
  goals, resources, and constituencies
• 3. Responding intelligently to the recent
  backlash surrounding end of life care, given
  public dialog and Federal health care reform.
• WBUR blog, and active response from Panel
  members via op-eds.
• 4. Maintaining and continually building upon
  momentum in MA to reach transformational (not
  incremental) change to improve palliative and
  hospice care for all MA residents when in need.
• Technical Advisory Group is being formed to guide
  development, implementation, and sustainability
  of the Panel/s final recommendations..

Dominique Kim, MPH
MA
Expert Panel on End of Life Care,
Sep. 2,
2009