New Jersey Goals of Care Expands Goals of Care Alignment Training Program with funding from The Horizon Foundation for New Jersey
In 2015, New Jersey Goals of Care (NJGOC), a 501(c)(3) organization, began implementing a Goals of Care Alignment Training Initiative made possible through a generous grant in the amount of $50,000 from The Horizon Foundation for New Jersey. Additional collaborators for the initiative include select medical residency training programs across the state, and two major New Jersey healthcare systems and their skilled nursing facility partners.
Founded in 2009, NJGOC seeks to educate and support physicians, healthcare teams, patients, and their families at all levels to ensure that a patient’s treatment decisions stem from the patient’s goals of care. To this end, NJGOC aspires to make it standard procedure to ask each patient about his or her personal goals of care at the bedside and in the doctor’s office, while enriching geriatric education to provide better prognostication and communication skills.
In the five years since its inception, NJGOC has trained many physicians and care providers to more effectively address a patient’s goals of care, and it has helped modify the existing national Practitioner Orders for Life-Sustaining Treatment (POLST) form template through participation in the New Jersey Hospital Association’s POLST Committee. Explicitly identifying the types of medical treatments a given patient might desire toward the end of life, POLST and its approved uses were ratified into law in NJ in 2013. Led by David Barile, MD, CEO, and Medical Director of NJGOC, the organization had previously established a POLST pilot program in 2011 with Princeton HealthCare System (PHCS), an integrated system in central New Jersey that includes University Medical Center of Princeton. NJGOC is now in the second year of initiating a similar pilot with AtlantiCare Regional Medical Center, part of the regional health system AtlantiCare based in Atlantic County, and four skilled nursing facility partners in the county. Together, the two pilot programs are expected to improve the healthcare experiences of approximately 10,300 patients.
“With this program having enjoyed great success at Princeton HealthCare System, we are eager to see how our lessons learned will be considered by other healthcare organizations,” expressed Barry Rabner, President and CEO of PHCS. “Through the awarding of this grant, Dr. Barile and NJGOC can continue their mission of helping to create a better dialogue around end-of-life issues, which are complex and often difficult to discuss. The program here at PHCS has been effective in aligning patient goals of care with available therapies and improving the end-of-life experience for people in New Jersey.”
“Our collaborative effort to improve care transitions and communication is making a difference in New Jersey for those facing the end stage of life,” explained Lori Herndon, RN, BSN, MBA, Executive Vice President, AtlantiCare, and President and CEO, AtlantiCare Regional Medical Center. “In taking a proactive approach to reducing avoidable re-hospitalizations, we, as a community of caregivers, are helping patients and families get quality, appropriate care that addresses their needs and wishes.”
As part of this initiative, NJGOC is preparing a series of 4 quarterly training programs on advance care planning, POLST, and geriatric care topics, to be conducted via Webinar with approximately 14 residency programs across the state. Together, NJGOC and its collaborators will consult with AtlantiCare, PHCS, and their partners to identify goals-of-care adoption successes and barriers and create and offer training to enhance provider-patient discussions of patients’ goals of care. For more information, please visit www.goalsofcare.org.
About The Horizon Foundation for New Jersey
The Horizon Foundation for New Jersey promotes health, well-being, and quality of life across our state by supporting charitable community organizations. For more information about the Foundation, visit www.HorizonBlue.com/foundation.
About New Jersey Goals of Care
Elder patients typically spend many weeks or months of their final years in hospitals. Seldom, however, do hospital providers have bedside discussions with them about their personal goals of care. New Jersey Goals of Care (NJGOC) was founded to address this problem, setting new standards for elder care and treatment. New Jersey ranks the highest in the nation for health care dollars spent on Medicare beneficiaries. Seniors in New Jersey can expect to see more doctors and undergo more tests during their final years of life than in any other state. While this high level of service may sound beneficial, the data show health outcomes for New Jerseyans are actually no better, and perhaps worse, when compared to other states. Unnecessary, burdensome care involving aggressive treatments or inadequate treatment is frequently out of sync with patients’ wishes.
In the past year, NJGOC has created a copyrighted four-step framework of curriculum development that moves the medical community from the two-step model of “diagnosis and treatment,” which is the most prevalent working practice model of providers today, to the four-step innovative NJGOC model of “diagnosis, prognosis, goal of care exploration and then treatment.” The focus is on helping to change the culture of physicians and other healthcare providers when communicating with patients around these critical junctures, as well as to empower patients and families to be better educated and prepared for these dialogues.
Our Goal: NJGOC seeks to achieve a much-needed culture change throughout health care for the elderly, making it standard procedure to ask each patient about his or her personal goals of care at the bedside and in the doctor’s office.
Our Mission: Our mission is to educate and support physicians, healthcare teams, and patients (and their families) at all levels to ensure that a patient’s treatment decisions stem from the patient’s goals of care, thus empowering the patient and improving both the quality and coordination of care.
Our Vision: We envision a revolution in geriatric medicine as it is instructed in the classroom and practiced at the bedside. Through our programs, we create an environment for the frail elder that is safe and protects their rights and their choices for care, while enriching geriatric education to provide better prognostication and communication skills. We aim to expand from New Jersey to a national level and then to the international arena. For further details about NJGOC, please visit www.goalsofcare.org.
AtlantiCare is an integrated system of services designed to help people achieve optimal health. It does so by focusing on customer needs and expectations to provide accessible, comprehensive services of superior quality and value. AtlantiCare is composed of AtlantiCare Regional Health Services, including AtlantiCare Regional Medical Center with campuses in Atlantic City and Pomona, and a satellite emergency department in Hammonton, ambulatory services, and AtlantiCare Physician Group; the AtlantiCare Foundation; and AtlantiCare Health Solutions, an accountable care organization. For further details about AtlantiCare, please visit www.atlanticare.org.
About Princeton HealthCare System
Princeton HealthCare System is a comprehensive, integrated healthcare system that strives to anticipate and serve the lifelong needs of central New Jersey residents. It comprises acute care hospital services through University Medical Center of Princeton at Plainsboro, behavioral healthcare through Princeton House Behavioral Health, rehabilitation, home care, hospice care, ambulatory surgery, a primary and specialty medical practice, and fitness and wellness services. For more information, visit www.princetonhcs.org.
The Horizon Foundation for New Jersey Awards $25,000 Grant to New Jersey Goals of Care for A Provider Training Service at AtlantiCare and Partners Commencing January 1, 2013
NJGOC Provider Training Services is a consulting and training initiative that will support training at AtlantiCare Regional Medical Center and its partners in order to improve provider-patient communication. The focus of the program is on goals of care-specific health literacy, as well as patient education concerning self-care and living better with chronic conditions or improving end-of-life decision-making. Measuring the effectiveness of communication and care transitions during and following hospitalizations, this project will pave the way to improve care, health literacy, and outcomes for those at-risk and/or over 65 years of age with multiple health conditions/complications. The intent of the program is to improve the health care experiences of these frail elder patients; train the teams to improve communication strategies; track data; study outcomes; and develop programs for professionals and other institutions, contributing to the national dialogue.
In sum, this project is of regional importance as a pilot project in working with health care facilities across the state in rolling out the newly approved POLST form and is also of national importance toward instilling this best practice that has been shown to reduce hospital readmission rates and improve patient outcomes while responding to recent changes in Medicare policies.
For further information, please click here to read the related press release.
Princeton HealthCare System’s Innovative and Award-Winning Partnerships for PIECE Initiative Awarded Two Grants and NJGOC Served as Primary Project Partner
Dr. David Barile, a national expert in geriatric care, who is not only CEO and Medical Director of NJGOC but also Medical Director of the Acute Care for the Elderly Unit of Princeton HealthCare System (PHCS)—has managed to make a dramatic impact toward achieving this desired culture change in health care across increasing circles of influence. Most recently, Dr. Barile has maintained an independent consulting role with the grant-funded project Partnerships for Patient Centered, Integrative Elder Care and Empowerment (Partnerships for PIECE). The Robert Wood Johnson Foundation’s New Jersey Health Initiatives awarded a $300,000 grant over two years to PHCS, for which Dr. Barile served as an independent consultant on behalf of New Jersey Goals of Care. Princeton HealthCare System also received a grant from the Blanche and Irving Laurie Foundation, which made the launch of Partnerships for PIECE possible.
As a part of this program—now in its second year— Dr. Barile has consulted with and trained all nine of the PHCS’s Skilled Nursing Facility partners (SNF’s) in the POLST pilot. Participating facilities are Merwick Rehabilitation, Meadow Lakes, Pavilions, Stonebridge, Elms at Cranbury, Park Place, Monroe Village, Princeton Care Center, and Cranbury Care Center. Refinements in training continue based on the organizational needs. Initial results have been promising, particularly in relation to the project’s core measures. PHCS has generously offered to share the information technology expertise it has garnered from this project with AtlantiCare for the Provider Training Service mentioned above.
Early data from the first full year of program activation suggests that Partnerships for PIECE is having a strong impact on reducing preventable re-hospitalizations, a central goal of the project, as well as other goals. These early successes have led to a national award, mentioned below.
- Innovative ‘Partnerships for PIECE’ Initiative Awarded Two Grants’
- PHCS is a Project of Promise ‘Project of Promise’ Winner of Hospital Charitable Service Awards Program
New Jersey Goals of Care Receives Grant for Website Education with Funding Provided from The Retirement Research Foundation and Coordinated by the National POLST Office
June, 2013. New Jersey Goals of Care (NJGOC) has received an award of $5,000 from The Retirement Research Foundation to participate in a cross state collaboration coordinated by the National POLST Paradigm Program Office to mentor the national development of Physician Order Life-Sustaining Treatment (POLST) Program. The purpose of this funding is to enable states to a) Develop and refine state-specific POLST educational materials, b) Efficiently disseminate such educational materials state-wide, and c) Enable awardees to travel to the National POLST Leadership Conference.
Through this grant, New Jersey Goals of Care plans to upgrade its website to create a toolkit which offers portals of information relevant to all the major audiences/constituencies relevant to the POLST, including facility administrators, physicians/health care providers, patients, family members, and other members of the interdisciplinary team who can help families to fill out POLST worksheets (such as nurses, social workers, and so on.).
As a part of our institutional commitment, New Jersey Goals of Care is producing a series of five minute videos for the NJGOC website. These videos will each be geared to the needs of one of several specific audiences: physicians/providers, administrators, patients, families, and the interdisciplinary teams. Each video will explain how to specifically use the POLST from the perspective of each audience, and will train the professionals involved to move from a two-step process of diagnosis and treatment to a four-step process of diagnosis, prognosis, determining patients’ goals of care, and only then determining treatment with the patient as partner. The video for the interdisciplinary team will focus on how to use the POLST for care planning meetings with a worksheet that has been developed and is currently being edited by stakeholders across the State in both governmental and health care capacities.
The generous funding provided by The Retirement Research Foundation shall pay for the technical aspects of this initiative, involving post-production video editing, placement on the website, and graphic/technical implementation, as well as some of the writing of educational content for each of our five audiences. The content will include tools that make these concepts easier for each audience including written narratives and PowerPoint steps to walk each audience through the POLST and goals of care processes.
Another aspect of this effort is to make the “e-POLST” training available so that it will be easier for the Information Technology departments of New Jersey facilities to adopt the electronic version of the POLST form. This aspect of the work has national significance in helping institutions meet meaningful use criteria in relation to the POLST.