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Neil Wenger, MD Catherine McGregor, MSN, FNS,C February 16, 2012

POLST in California: Use in Nursing Homes & Hospitals, Quality of Completion and Impact of Community Coalitions. Neil Wenger, MD Catherine McGregor, MSN, FNS,C February 16, 2012. POLST Implementation in California. POLST mandated by California law Jan 2009

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Neil Wenger, MD Catherine McGregor, MSN, FNS,C February 16, 2012

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  1. POLST in California:Use in Nursing Homes & Hospitals,Quality of Completion andImpact of Community Coalitions Neil Wenger, MD Catherine McGregor, MSN, FNS,C February 16, 2012

  2. POLST Implementation in California • POLST mandated by California law Jan 2009 • California HealthCare Foundation and Coalition for Compassionate Care of California statewide implementation • Began in 2007 • Statewide taskforce of stakeholders • Educational materials and standardized approach • Local grassroots coalitions

  3. Survey to Evaluate Nursing Home and Hospital POLST Use • Survey instrument development • Statewide POLST Taskforce • Community Coalitions • California Association of Health Facilities (CAHF) • Mailed and electronic survey • Telephone follow up

  4. Survey to Evaluate Nursing Home and Hospital POLST Use • Topics • Experience of with POLST • POLST policy • POLST education and needs • POLST handling and attitudes • Problems with POLST

  5. Evaluation of POLST Dissemination in California • Nursing home use, statewide • 2010 • Coalition and non-coalition areas • Hospital use, statewide • 2011 • Nursing home POLST quality • 2010 and 2011 • Coalition areas

  6. Community Coalition areas Non-Community Coalition areas

  7. Nursing Home POLST Evaluation:Sample selection • Selected SNFs from each study county • Up to 20 SNFs in each county • If >20 SNFs, randomly selected • If Community Coalition county, select 50% as partner SNFs • Partner SNFs randomly selected • Backfilled to maximize county sample

  8. SNF Sample for Survey

  9. CA Nursing Homes, 2010: POLST Preparation (N=283/546)

  10. Nursing Home POLST Evaluation:Sample selection • Selected SNFs from each study county • Up to 20 SNFs in each county • If >20 SNFs, randomly selected • If Community Coalition county, select 50% as partner SNFs • Partner SNFs randomly selected • Backfilled to maximize county sample

  11. CA Nursing Homes, 2010: POLST Use

  12. Percentage of Residents Admitted in Past 30 Days with a Completed POLST # of SNFs

  13. CA Hospitals, 2011: POLST Preparation and Use (N=286/345)

  14. Effect of Coalitions:Admitted a Resident with a POLST

  15. Quality of POLST Completion in Coalition Area Facilities • What is the quality of completion of POLST forms from Nursing Homes with which Coalitions worked? • Is there improvement in completion with feedback of findings?

  16. Quality of POLST Completion in Coalition area Nursing Homes • Convenience sample of 6 SNFs in each of 5 coalition areas • Orange County, Sacramento, San Diego, San Fernando Valley, Santa Clara • July/August 2010: Review of 538 randomly selected charts with POLST forms • Feedback of findings to SNF • July/August 2011: Review of 594 randomly selected charts with POLST forms

  17. POLST Key Findingsin SNF, 2010 and 2011 *Error makes the POLST form invalid **p<0.01 for comparison of 2010 to 2011

  18. Challenges and Opportunities • POLST…another thing to do • Staff turnover • Lack of education/scarce resources • Diverse cultures • Explaining CPR, prognosis, statistical outcomes • Difficulty in having goals of care conversations • Physician engagement • Processes in getting the POLST back from Hospitals

  19. Summary of Findings • 18 months after implementation, substantial uptake of POLST in SNFs • Most facilities had structures and staff education • 2/3 of SNFs had admitted a resident with a POLST • 80% had used POLST in their SNF • By 2011, hospitals using POLST regularly • Community Coalition mechanism increased dissemination of POLST • POLST quality generally good • Documentation difficulties common after 18 months improved with feedback

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