Last week I gave a talk at the medical school about high-performing healthcare systems and what they are doing to improve quality and lower the cost of healthcare for their communities.
One of the systems I highlighted during the talk is Gunderson Lutheran in Lacrosse Wisconsin. The cost of care for a Medicare beneficiary living in Lacrosse Wisconsin is the lowest in the country. They do a lot of things well at Gunderson Lutheran, but the thing that sets them apart is their advance directive program.
At Gunderson caregivers routinely have conversations with their patients about advance directives long before the patients are in a situation where they need to use them.
Advance directives are documents that allow people to communicate their decisions about medical care to family, friends, and health care professionals in the event that they are unable to make those decisions themselves—for example, due to being unconscious or in a coma.
In La Crosse, Wisconsin, those wishes are then documented in the patient’s chart and flagged in a way to immediately get the attention of any emergency care provider.
The reward for this simple but extremely valuable effort is an average of approximately 10 fewer days in the hospital during the last two years of life for patients treated at Gunderson Lutheran; and a 30% reduction in medical expenses during the same time frame.
End of life care has become increasingly important as our population ages. Studies indicate that in Massachusetts, 67% of people would prefer to die in the comfort of their own home, yet in actuality, only about 24% actually do. (Sources: Massachusetts Commission on End of Life Care and MA Chapter AARP, End-of-Life Survey, 2005; and Massachusetts Department of Public Health, Massachusetts Deaths 2007 – As published by the Expert Panel on End of Life Care: http://www.molst-ma.org/sites/molst-ma.org/files/FINAL-EXPERT-PANEL-REPORT-APPROVED.pdf )
The Gunderson Lutheran story reminded me of an interesting Saturday Evening Post article entitled “ How Doctors Die” http://www.saturdayeveningpost.com/2013/03/06/in-the-magazine/health-in-the-magazine/how-doctors-die.html/2 Although we doctors spend an exorbitant amount of time in hospitals during our prime, we tend to spend very little time there as patients in our last few years of life.
We were the pilot site for the state roll-out of MOLST, the Massachusetts Orders for Life Sustaining Treatment. These forms follow the patient from site to site, and provide emergency medical personal with a medical order indicating end-of-life preferences for these patients. (http://www.molst-ma.org/)
In our EMR, health care proxy forms and MOLST forms can readily be found in Allscripts charts.
We are also currently developing exciting new initiatives to make advance care planning easier for our community. More information will come about this as we near National Healthcare Decisions Day in mid-April.
For a great video on advanced directives and living wills (Tom Brokow and his daughter) click on this link https://www.youtube.com/watch?v=fvYSlL65kLM
Thanks for everything you do to take great care of our patients and one another,
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I have been working in the ICU in Marlboro for 12 years and have seen 2 Molst forms only! The physicians in our community do not appear to be using them and when the patients come to us, the Hospitalists do not have a history with the family/patient so they do not address it either. I think this needs to be promoted in the Community–we have many readmissions for quite frail elderly patients who are in decline for an entire year and we continue to give complex treatment because the families are not clear what to do!