Online Program

Creation of medical orders for life sustaining treatment: Health care reform

Wednesday, November 6, 2013

Andy Epstein, RN, MPH, Massachusetts Department of Public Health, Boston, MA
The Affordable Care Act will alter the way that health care and public health serve the elderly. One significant way is through an expanded effort to deliver care on a more patient centered manner. Reimbursement will be available to counsel patients - particularly elderly patients– about the importance of considering the end of life and the types of services they would or would not want to receive under different conditions. The Massachusetts experience offers insight into what this might mean for the rest of country. As a component of the Massachusetts health care reform initiative which was implemented several years ago, there was an explicit requirement that an end of life commission be constituted to provide recommendations for action. One of those recommendations involved the creation of Medical Orders for Life Sustaining Treatment (or MOLST) initiative with a systematic approach to engaging patients and family members in a process to direct their own care. A pilot of a statewide MOLST program has been implemented in a county of the state and preliminary findings offer useful lessons regarding what is needed to expand such an effort throughout the state and the nation. A uniform state-endorsed form has been developed, training materials have been developed and utilized with a wide range of providers – including EMS, hospitals and nursing homes - and families. Preliminary efforts are underway to expand the program in Massachusetts, which would make it the largest government overseen effort of its type in the nation.

Learning Areas:

Clinical medicine applied in public health
Other professions or practice related to public health
Provision of health care to the public
Public health or related nursing
Public health or related public policy

Learning Objectives:
Describe how health care reform may affect the health of the elderly. Discuss the ways that the Medical Orders for Life Sustaining Treatment (MOLST) program's preliminary findings offer useful lessons regarding the expansion of life sustaining treatment efforts. Identify how to link the public health and prevention approaches to clinical care in work with the elderly. Analyze innovative and evidence-based approaches that are currently being used for work with elderly people.

Keyword(s): Elderly, Health Care Reform

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a special assistant to the Commissioner of Public Health in Massachusetts. In this role I am involved in overseeing a variety of key priority projects for the state.One of the most significant has been promoting the use of a standardized Medical Order for Life Sustaining Treatment or MOLST form. I have also worked for decades as a public health nurse in multiple settings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.