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CHCF Directs $2 Million to Spur Adoption of New End-of-Life Communication Tool

Recently approved POLST form gives seriously ill patients greater ability to control medical treatment

CHCF will provide over $2 million in grants to help educate health care providers about a communication tool that gives seriously ill patients greater control over their end-of-life medical care.

The California HealthCare Foundation (CHCF) has announced plans to provide over $2 million in grants to help educate health care providers about a new communication tool that gives seriously ill patients greater control over their end-of-life medical care.

The new tool, called the Physician Orders for Life-Sustaining Treatment (POLST), is a brightly colored document that addresses issues such as pain management, resuscitation orders, feeding procedures, and other medical interventions. The form is completed with the approval of both the patient and the physician. It is different from an "advance directive" because it has the force of a physician's medical order and remains with patients wherever they receive care.

More than 20 states have, or are developing, POLST programs. Last year, Governor Schwarzenegger signed legislation requiring POLST forms to be honored across all settings of care in California and provided immunity to clinicians who honor a POLST document in good faith. The new law took effect on January 1, 2009.

In August 2007, CHCF committed $120,000 to promote POLST, working with the Coalition for Compassionate Care of California to manage the creation of a statewide task force and seven local coalitions. In late 2008, CHCF directed an additional $2.14 million to the POLST initiative, including grants to an additional ten community coalitions to expand the POLST effort. The Foundation also is funding a statewide outreach campaign to communicate with nursing homes, emergency medical service providers, and physicians and nurses who treat seriously ill patients.

POLST is intended to avoid unwanted or medically ineffective care, reduce patient and family suffering, and ensure that patients' wishes are honored at the end of life.

"All of us have watched friends and family members struggle to control their health care treatment in their final months. POLST is a hugely important innovation that gives seriously ill patients an unprecedented ability to influence the type of care they receive," said Mark D. Smith, M.D., M.B.A., president and CEO of CHCF. "We want to make sure that every provider who delivers end-of-life care becomes familiar with POLST."

According to a recent study published in the Journal of the American Medical Association (JAMA), end-of-life discussions between physicians and patients are associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care is associated with worse patient quality of life and worse adjustment in the bereavement process.

The 17 local organizations receiving grants are:

  1. Alameda-Contra Costa Medical Association, Alameda County
  2. Anderson Valley Health Center, Mendocino County
  3. Channel Islands POLST Group, Ventura County
  4. Community Network for Appropriate Technologies, Sonoma County
  5. Compassionate Care Alliance, Monterey County
  6. Greater Bakersfield Better Care Coalition, Kern County
  7. Hospice of Santa Cruz, Santa Cruz County
  8. Humboldt Independent Practice Association, Humboldt County
  9. Inland Empire Palliative Care Coalition, Riverside County
  10. Inland Empire Palliative Care Coalition, San Bernardino County
  11. Monarch Healthcare, Orange County
  12. Queen of the Valley Medical Center, Napa County
  13. San Diego County Medical Society, San Diego County
  14. Southern California Bioethics Committee Consortium, West Los Angeles
  15. Valley Care Community Consortium, San Fernando Valley
  16. VMC Foundation and Santa Clara County Medical Center, Santa Clara County
  17. Woodland Healthcare Foundation, Yolo County

The Coalition for Compassionate Care of California, a partnership of more than 60 statewide and regional organizations dedicated to the advancement of palliative care and compassionate end-of-life care in California, continues to lead the initiative. For more information about POLST, visit www.finalchoices.org.

About the California Health Care Foundation

CHCF is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.

CHCF informs policymakers and industry leaders, invests in ideas and innovations, and connects with changemakers to create a more responsive, patient-centered health care system.

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