The Louisiana Health Care Quality Forum is partnering with California-based advance care planning technology firm Vynca and the Ochsner health system to implement a statewide registry for the bayou state’s Physician Orders for Scope of Treatment (LaPost) forms and advance directives.
LaPOST documents contain advance directives, patient wishes and goals for end-of-life care and often designate a surrogate decision maker should the patient become unable to communicate. One critical goal for the new registry is not only to assist patients in completing these documents, but creating digital records that are easily accessible to health care providers, including those responsible for the patients’ end-of-life care.
“As we have been out there educating on advanced care planning and the the different associated documents, we knew that the paper format created several issues. Most importantly, it would not be available during emergencies, and you never knew whether or not it was the most recent version,” Quality Forum CEO Cindy Munn told Hospice News. “There may be times when the document was either incomplete or what was selected was incongruent. For example, at times the ‘Do Not Resuscitate’ section would be marked off, but then the medical interventions was designated ‘all interventions.’”
Incomplete or inaccessible end-of-life documentation is an ongoing problem nationwide. Recent research indicated that nearly 40% of patients in a two-hospital academic health system received end-of-life services in an intensive care unit, contrary to their wishes as documented in Physician Orders for Life-Sustaining Treatment (POLST), often because of errors in their documents or because health care providers could not access the documents.
Studies show that advance care planning can reduce hospitalizations by as much as 26%, reduce health care costs, increase community-based palliative care and hospice utilization, as well as significantly increase the likelihood that care will be delivered in accordance with the patient’s wishes.
Despite the benefits of advance care planning, many patients don’t pursue it or pursue it too late. Only 14% of patients with serious illnesses have advance care plans, research shows, a trend that many health care providers, payers and policymakers are working to reverse.
“As we look at the broader post-acute spectrum, which includes palliative care programs and includes hospices, we’re uncovering a lot of unmet needs in the process of understanding a person’s goals and making sure they fit into a care plan and then ensuring as a result of that they have access to hospice or other services,” Ryan Van Wert, M.D., CEO of Vynca, said. “The registry piece is an aggregation of any care plan that we manage and that we receive into our central secure cloud. This allows us to make sure that there is a single source of truth, whether it’s for the patient or the caregiver or for a clinician, to access the most up to date and accurate documentation for that patient when it’s needed to direct care.”
Vynca develops technological solutions to bolster education and engagement in advance care planning conversations, shared decision making, digital completion of documents as well as accessibility of those documents to patients, families and health care providers.
Ochsner, the state’s largest nonprofit academic health systems, will be the first health care system to join the Quality Forum collaboration with Vynca to manage Louisiana’s state-wide electronic registry, which will be available to health care providers across all settings.
“Advance care plans are designed to give the patient a voice in situations where they are unable to speak for themselves. Ochsner recognizes digital access to advance care planning documents and LaPOST forms will ensure that our patients, as well as their families and care teams, have the information available when they need it,” said Susan Nelson, M.D., system chair of palliative medicine at Ochsner. “The partnership with Vynca and the Louisiana Health Care Quality Forum, allows us to create momentum so that one day digital access for vital advance care planning documents will be the norm.”