The Foundation for Post-Acute and Long-Term Care Medicine has announced its 2020 Quality Improvement (QI) and Quality Improvement & Health Outcomes (QIHO) Award recipients. The QI Award went to Fatima Sheikh, MD, MPH, CMD, and her team at FutureCare NorthPoint in Baltimore, MD, for the project “Understanding Long-Term Care Residents’ Perceptions on Interdisciplinary Care Plan Meetings.” Howard Finger, DO, of Coler Rehabilitation and Nursing Care Center in Roosevelt, NY, won the QIHO Award for his program, “MOLST PI Project/Application of the Algorithm for the Unbefriended in Conjunction with the MOLST Form PI Initiative.”
Dr. Sheikh, assistant professor in the Division of Geriatrics at Johns Hopkins School of Medicine and medical director of FutureCare Capital Region and NorthPoint Facilities, said, “Winning this honor was a humbling but delightful experience.” Referring to the lead investigators on the project, Chitra Hamilton, MD, and Mariah Robertson, MD, Dr. Sheikh said, “Their project is very unique as it focuses on understanding long-term care residents’ perceptions of interdisciplinary care plan meetings. This is an innovative project with demonstrable impact on the quality of care for patients in the nursing home setting. I am extremely proud of Drs. Hamilton and Robertson on this performance improvement project and their overall motivation and commitment to their long-care residents.”
Dr. Hamilton said, “Our biggest goal with this project is to learn more about barriers to and facilitators of the care planning process. What are residents’ and families’ frustration with this process? What do they like about it? How would they like to be more involved?” Dr. Robertson added, “Our study highlights the importance of having excellent care planning and lines of communication with residents and families. This population is especially vulnerable, and the family is often very involved in care planning. We need to make sure that we engage them in a way that is both productive and comfortable for them.”
Dr. Robertson observed that the COVID-19 pandemic has amplified the significance of their study. “We are hopeful that this will improve communication so that we can maximize resident and family education and make it more useful for them.” She added, “It’s an incredible honor to be selected for this award. As young practitioners, it helps fuel our passions.” Dr. Hamilton noted, “I’m a new AMDA member and will be a medical director in the coming year. It’s so rewarding that this project was embraced with open arms by the AMDA community.”
Dr. Finger, who is the clinical ethics consultant at Coler and the co-chair of the NYC Health and Hospitals Bioethics Council, noted that this was a combined principal investigator (PI) process. He was the team leader of the Application of the Algorithm for the Unbefriended in Conjunction with the MOLST Form PI Initiative, and Chery A. Dury, director of social work at Coler, was the team leader for the MOLST PI Project.
Speaking of his project, Dr. Finger said, “Patients who lack a surrogate and the ability to make informed medical decisions — often referred to as the ‘unbefriended’ — pose moral and ethical dilemmas and undue stress for the clinical care team.” He added, “We wanted to address this weakness in the health care system at large and use it as an opportunity to develop an aid that guides an ethical, compassionate, and careful framework for all providers, one that minimizes ambiguity and the potential for arbitrary decisions to be made involving the most vulnerable population.”
Initial results of their ongoing PI initiative are promising, Dr. Finger said. “We recently completed a retrospective mortality review from the time we implemented this combined PI process in June 2018 until February 2020 and discovered that 24 unbefriended Coler residents with advanced life-limiting illness and lacking decisional capacity had died during the time span.” In terms of advance care planning/palliative measures in place at the time of death, all 24 had at least a do-not-resuscitate (DNR) order and 22 of the 24 had DNR and do-not-intubate (DNI) orders, along with orders in effect to withhold or limit short-term acute care discharges, he said.
The results of an earlier satisfaction survey showed that 96% of care team members said the process in place helped relieve their apprehension and moral distress, enabling them to better address the end-of-life care planning needs of this vulnerable population. He observed, “Most significant among the outcomes was that unnecessary or unwanted treatments were largely avoided in the vast majority of unbefriended residents. For these individuals, who were elderly, frail, and debilitated, the interdisciplinary ethics panel endorsed a reduction in patient transfers for acute care, thereby sparing them from medically inappropriate, burdensome treatments that would have been of little benefit.”
The QIHO award “validated the work we are doing. It was rewarding to receive recognition from a peer organization that understands this issue,” said Dr. Finger. “I was at the AMDA virtual annual conference, and this topic came up in discussions about advance care planning. This is so important, as we are the voice of a population that often is ignored or forgotten. It’s so important that we rise up and make this voice heard.”
The QI Award is designed to encourage the development of innovative projects that will help to make a distinct impact on the quality of PALTC. This award supports initiatives that focus on facility staff education, quality improvement programs, research on interventions and treatment, and health literacy to directly enhance the quality of care provided to patients in PALTC settings. For more information, go to paltc.foundation.org/node/295
The QIHO Award recognizes programs medical directors and care teams have implemented to improve the quality of life for their residents. For more information, go to paltcfoundation.org/node/293