Summit on the Care of the Seriously Ill:

An Update on the SC Coalition for the Care of the Seriously Ill ( SC CSI)

October 12, 2011

John C. Ropp, III, MD, Chairman, SC CSI

The Continuum of Care: Care Transitions

The Continuum of Care: Care Transitions

The Continuum of Care: Care Transitions

The Continuum of Care: Care Transitions

The Continuum of Care: Care Transitions

Stakeholders

SC Coalition for the Care of the Seriously Ill ( SC CSI)

•Founding Members: SCMA, SCHA, TCC, SC Healthcare Ethics Network, LifePoint, AARP, SC Nurses Association

•Additional Representation: SC Bar, Lt. Gov. Office, SC DHEC EMS, SC Chaplains Assoc, SC Healthcare Assoc

•Mission: All persons in SC with serious, chronic, or terminal illnesses will have an active voice in the care decision process

What’s the Problem?• 1. Current EOL Care often does not reflect

patients’ values and preferences.

• 2. EOL Care costs a lot of money compared to other healthcare expenditures.

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• Almost 50% of U.S. population has at least one chronic medical condition, consuming 80% of healthcare resources

– Hypertension is the most common chronic condition, with 50M+ people in the U.S. needing treatment for high blood pressure

– 23M people have asthma, with economic costs projected at $20B in 2010

– 24M people have diabetes; one-fourth are unaware they have it

• Between 2005 and 2030, the number of Americans with chronic conditions will increaseby almost 30%

– 20% to 30% of all Americans are projected to have diabetes by 2050

Sources: Partnership for Solutions, John Hopkins University; Health Affairs, 26, no. 1 (2007): 142-153

Large and Growing Problem: People with Chronic Medical Conditions

118

125

133

141

149

157

164

171

100

120

140

160

180

1995 2000 2005 2010 2015 2020 2025 2030

Number of People With Chronic Medical Conditions (in millions)

5+ chronic conditions

66%

No chronic conditions

1%

4 chronic conditions

13%

1-2 chronic conditions

10%

3 chronic conditions

10%

Source: G. Anderson and J. Horvath, Chronic Conditions: Making the Case for Ongoing Care. Baltimore, MD: Partnership for Solutions, December 2002.

Medicare Beneficiaries - Chronic Conditions & Spending

4 Aims 1. Education/tools for healthcare professionals

• Toolkit with sample policies developed by physicians: C-ROS; Communication, Consent, Decision-making Process for Seriously Ill Inpatients

• Improve communication as patients transition across the continuum of care

• Identification of patient values, beliefs, and wishes regarding their own healthcare

• Best practices for honoring advance directives regardless of setting

4 Aims2. Education/tools for patients and communities

•Advance Directives•Healthcare decision making • Understanding their diagnosis and what they can do

3. Appropriate relationship-centered care in all settings

•Establish palliative care in all SC hospitals; expand palliative care training•County-level mapping of resources for chronic, serious, terminal illnesses and make information accessible

4 Aims4. Policy/Advocacy-Legal & RegulatoryAdvocate for the alignment of requirements and policies related to the care and decision-making processes for the care of seriously, chronically, or terminally ill persons

• Consider feasibility of ‘durable DNR orders’• Consider POLST for SC (Physician Orders for Life-Sustaining Treatment Paradigm)

Future Directions for SC-CSI• 4 Aims: Tools for Healthcare Professionals,

Tools for Patients/Communities, Care in all Settings, Policy Advancement

• Continue to pursue appropriate grants• Support local healthcare systems that

pilot/study EOL care issues

Future Directions for SC-CSI

• Form Subcommittee level work groups to accomplish the Aims

• Become the voice for EOL care issues in SC