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State continues quest to lower end-of-life care costs

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Another tool has been added to the roster for decreasing the cost of end-of-life care and increasing compliance with patients' wishes.

Mary O'Dowd

The POLST form — short for practitioner orders for life sustaining-treatment — debuts today, following its creation by the Department of Health, with help from a steering committee. It's a form to be kept with patients who have life-limiting illnesses as a way to guide their care.

Unlike an advanced directive, the POLST form is an actual medical order, and is completed by both the patient and the physician or advanced practice nurse. It becomes a permanent part of the patient's medical record. Advance directives give direction for future care, and can appoint a surrogate decision maker for the patient, but are not applicable to emergency medicine personnel. The two forms are meant to complement each other.

For providers, the POLST form also will prevent unnecessary spending on expensive interventions when the patient may want to take a therapeutic, not curative, direction. It also provides a conversation-starting point for providers who have not yet discussed end-of-life care with chronically ill patients.

"New Jersey is the highest in the country (in) spending in the last two years of life, as well as the last six months of life," said Health Commissioner Mary O'Dowd. "That would be OK if it corresponded with better outcomes or quality of life," but that hasn't been the case.

O'Dowd said the POLST form is a step in a multitiered effort to engage the public.

Nine skilled-care facilities have tested the form for the past year, and found it helps initiate conversations and direct practitioners to follow patients' wishes.

Fifteen states already have endorsed the use of POLST forms as a way for patients to guide their care to coincide with their wishes. The program began in Oregon in the early 1990s.

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