WEST VIRGINIA HEALTH CARE AUTHORITY
END-OF-LIFE CARE - EXPERT PANEL
MEETING SUMMARY - OCTOBER 1, 2001
A conference call with members of the Expert Panel on End-of-Life Care was held on October 1, 2001. The call originated at 1:00 pm and concluded at 2:30 pm. Members of the panel participating in the call included: Joan Armbruster; Sonia Chambers; Cathy Chadwell; Mary Emmett, Ph.D.; Charlene Farrell; John Grey; Sallie Hunt; Alvin Moss, MD; Larry Robertson; Sue Warren, MD; and Linda Sovine.
The purpose of the call was to review the recommendation from the Quality Utilization Advisory Group and provide advice on the method for addressing each of the recommendations. Finally, the participants were asked to provide updates on palliative care pain assessment, hospice pain assessment, the Minimum Data Set (MDS) for Nursing Homes and developing a publishable paper.
The End-of-Life Care Quality Indicators were reviewed. Two Health System Indicators were modified. Hospitals with Palliative Care Teams were changed to Hospitals with Palliative Care Services. Nursing Homes with Palliative Care Teams was changed to Nursing Homes with Palliative Care Services. (See Attachment 1 and Attachment 2 )
The recommendations from the Quality Utilization Advisory Group were discussed and consensus reached regarding "proposed indicators" and "future indicators." The panel noted that Health System's Indictors, which record transfer data, may or may not be useful depending on the wishes of the person being transferred. A recommendation was made to modify the annual Nursing Home Survey conducted by the Health Care Authority to include a question that captured the number of transfers from the nursing home to a hospital and the person died in the hospital.
Some discussion followed on the value of using Emergency Room Visits in the last six months of life as an indicator. No consensus was reached on this suggestion.
Pain Management -- A resident assessment protocol for pain assessment and management as part of the MDS is still in draft form. Hospital information will be available when the Joint Commission makes that data publicly available.
The panel considered an indicator that measured nutrition. The consensus was to collect data on use of G-Tubes for persons receiving palliation services and hospice services. A definition for "feeding tube" is "the presence of any type of tube that can deliver food/nutritional substances/fluids/medications directly in the gastrointestinal system." Examples include nasogastric tubes, gastrostomy tubes, jejunostomy tubes, and PEG tubes. The data can be extracted from the MDS, Palliative Care Data Collection Tool, and included on the annual Hospice Survey.
Use of the Physician Orders Scope of Treatment (POST) was restricted to the nursing homes. Efforts are currently underway to increase use of the form in nursing homes. A question will be added to the annual Nursing Home Survey, which captures the number of residents who in the past twelve months have completed the POST.
The publics understanding of end-of-life care and respect for individual preferences can be measured using data collected through the Behavioral Health Risk Factors Survey (BRFS). The questions on the survey are included as an attachment (see Attachment 3).
Palliative Care pain assessment indicators were approved by the Palliative Care Task Force and will be included on the data collection tool. Data collection will begin in October 2001.
Hospice Pain Assessment has not started. This will be discussed by the Hospice Council and included on the annual survey of hospices.
The Health Care Authority is acquiring the Minimum Data Set data. When the data are available analysis will begin to understand pain assessment, use of restraints and nutrition using feeding tubes.
The panel suggested waiting until data can be reported before submitting an article for publication.
The discussion adjourned at 2:30 pm. Communication with the panel will continue when data are available to report.