A recent study, “Days Spent at Home — A Patient-Centered Goal and Outcome,” published in the New England Journal of Medicine suggests quality measures of health care should focus on what patients want, not what providers do. As we continue to transform our health care system aiming to improve outcomes, our measures must align with the person’s goals for care.

Not surprisingly, the authors found that the region in which people live plays a large role in determining what portion of time in their final months they spend at home or in a healthcare facility. In examining data provided in the Supplemental Appendix, variation exists. There is a clear distinction in average days in the community between Upstate and Downstate New York.

One possible reason for the wide variation could be different ways physicians practice medicine. Another possible explanation is the population health approach Excellus BlueCross BlueShield (EBCBS) uses to improve quality end-of-life care since 2001.

As part of its mission, EBCBS has supported the development and implementation of person-centered community initiatives that improve the quality of end-of-life care. Key examples are the two complementary advance care planning programs: Community Conversations on Compassionate Care and Medical Orders for Life-Sustaining Treatment (MOLST), that align with recommendations in Institute of Medicine Dying in America report. The CCCC program frames advance care planning as a wellness initiative and advocates for early advance care planning discussions and completion of a health care proxy. New York’s MOLST program is an endorsed POLST Paradigm Program. The community programs are integrated into care management and other cross-functional areas.

A second study, “The Role of Advanced Practice Registered Nurses in the Completion of Physician Orders for Life-Sustaining Treatment (POLST),” reviewed who signed POLST forms submitted to the Oregon registry. The study did not examine process.

New York is identified as one of the three endorsed states who do not allow nurse practitioners to sign POLST Paradigm forms. While New York’s public health law only allows for licensed physicians to confirm and sign MOLST orders, nurse practitioners are already routinely involved in the MOLST process in our state. For NY, more than signature is required as there are other aspects to our laws on withholding/withdrawing life-sustaining treatment where only “attending physician” can participate. Pending legislation will address needed changes to expand scope of practice for NPs.

Future research needs to focus on what matters most to the person. Effective communication about personal goals, preferences and shared informed decision making about what can and cannot be accomplished is critical. As we accelerate digital transformation to the NYSeMOLSTregistry.com and regularly access key information from the Vital Statistics database, we will be able to correlate goals, preferences for hospitalization and site of death.

National POLST launched a new website in early fall. The revised POLST.org site separates patient and professional information. Navigation has been entirely reorganized. The POLST Paradigm national map is available with easy-to-download PDF. More space is dedicated to public education on advance care planning and the role of the POLST Paradigm program. Newly available are our eNewsletters archives, media information, and better-organized and updated video and resource libraries.

When faced with questions regarding the status of implementations of the National POLST Paradigm program in other states, POLST.org is the best resource. State leaders and contact information is posted as well as links to state-specific websites.

Check out the new website and email feedback!

Completion of both the first and second pages of the MOLST form is strongly encouraged. However, the patient or medical decision-maker may not be physically or emotionally prepared to reach a decision concerning every treatment option on MOLST in a single meeting

Completion of only page 1 of the MOLST form (concerning CPR/DNR) is permissible, and page 2 (Section E) may be completed at a later time.

By Katie Orem, MPH

ACP Mastership
The American College of Physicians (ACP) Board of Regents recently voted to elect Dr. Pat Bomba to Mastership. Dr. Bomba was nominated by several colleagues in the ACP including Dr. Maria Carney, Division Chief for Geriatrics & Palliative Medicine at Northwell Health. Dr. Carney, who also serves on the NY MOLST Executive Committee, stated that she was “pleased and honored to nominate Dr. Bomba for an ACP Mastership given her distinguished leadership on MOLST and advance care planning initiatives in New York State and her passion and unwavering dedication to improving care for all New Yorkers, especially involving health care decisions at life’s end.”

According to the ACP, the Mastership award is conferred only on a select number of worthy candidates who are deemed distinguished through a combination of achievements, including the practice of internal medicine, academic contributions, and service to the ACP. In making decisions about each candidate’s suitability for Mastership, the Committee considers qualities such as strength of character, integrity, perseverance, leadership, compassion, and devotion, as well as clinical expertise and commitment to advancing the art and science of medicine. Emphasis is placed on service as a teacher and mentor, advocacy for quality in internal medicine, a commitment to social justice, deep interest in people, and the creation of communities of medicine. Additionally, the Master should be a “citizen physician,” educational innovator, humanist, and learner-teacher who inspires others to seek high standards and excellence in the specialty of Internal Medicine (ACP, 2016). As a Master of the American College of Physicians, Dr. Bomba embodies these qualities.

Dr. Bomba’s Mastership will be presented on Thursday, March 30, 2017 at the Convocation ceremony during ACP’s Internal Medicine Meeting in San Diego, California. During that meeting, she will be formally conferred with her Master’s hood and diploma. View a complete list of the 2016-2017 ACP Masters & Awardees.

Amethyst Award
Dr. Bomba also received the Immaculata University Alumni Association 2016 Amethyst Award at its annual gala on October 21st. The Amethyst Award is presented to an alumnus in recognition of her outstanding contributions or achievements in church, community, or professional activities. The recipient supports and exemplifies the goals, ideals, and values of an Immaculata University education. Dr. Bomba was recognized for her life-long commitment of service to her profession, community, church and family. She was cited as a social entrepreneur for her visionary leadership of New York’s MOLST and eMOLST programs. She was also highlighted for her national and international leadership as a founding member of the National POLST Paradigm Task Force, service on the Institute of Medicine committee that produced Dying in America, and her recent work on MOLST and eMOLST with South Korea.