Massachusetts MOLST Expansion Project Presentation: STAAR Learning Summit October 12, 2011 Christine McCluskey, RN, MPH, MOLST Project Director, Commonwealth Medicine Center for Health Policy and Research Commonwealth Medicine UMass Medical School

MOLST in Massachusetts A process for discussing, documenting, communicating & honoring patient preferences for life-sustaining treatments A standardized form for writing & communicating medical orders for life-sustaining treatments A portable document that travels with the patient & is honored by health care professionals across care settings Voluntary for patients of any age who are nearing the end of life Center for Health Policy and Research Commonwealth Medicine UMass Medical School 2

Key facts about MOLST in MA Center for Health Policy and Research Commonwealth Medicine UMass Medical School 3 Part of advance care planning, but not an advance directive, and it takes effect immediately on completing form Is an implementation tool for advance care planning conversations applied to current medical decision making Represents the standard of care for documentation of patient and clinician discussions with the resulting medical orders Can be used to refuse or accept life sustaining treatments

MOLST Form Page 1: Medical Orders for Life Sustaining Treatments DNR, DNI, DNH Page 2: Statement of Patient Preferences for Other Medically Indicated Treatments Center for Health Policy and Research Commonwealth Medicine UMass Medical School 4

Increasing Conversations between clinicians and patients about patient prognoses, values & goals of care; Patient understanding about medically-indicated treatments; Documentation of patient treatment preferences ; Communication of preferences across treatment sites; and Decreasing The use of treatments that the patient does not want. MOLST Goal: to improve patient-centered care by Center for Health Policy and Research Commonwealth Medicine UMass Medical School 5

MOLST and the Health Care Proxy MOLST does not replace the need for all adults (age 18 & older) to complete a Health Care Proxy form to appoint a health care agent. A health care agent is the person authorized to make health care decisions on one’s behalf in the future if one loses capacity to make health care decisions. A MOLST form contains medical orders based on a patient’s own preferences. It is suitable for very sick patients nearing the end of life & goes into effect as soon as it is signed. Center for Health Policy and Research Commonwealth Medicine UMass Medical School 6

Transitions of Care & MOLST HOSPITALREHAB NURSING HOME HOME OUTPATIENT MOLS T Center for Health Policy and Research Commonwealth Medicine UMass Medical School 7

MOLST Statewide Expansion Principles 1. Strategic Collaboration Collaborate with statewide, cross-continuum initiatives already underway in MA Don’t “re-invent the wheel” 2. Capacity Expand MOLST first in organizations that have both interest in MOLST & capacity to implement MOLST Expand MOLST to other health care organizations & institutions in the Worcester area Center for Health Policy and Research Commonwealth Medicine UMass Medical School 8

For more information go to Center for Health Policy and Research Commonwealth Medicine UMass Medical School