Instrument NN
Title:California POLST Minimum Data Set Questions
Designer: Neil Wenger, MD, MPH. Please credit him in any future work:
Suitable for Quality Improvement? Yes, modified to fit your state.
Suitable for research? Yes, especially if you are planning to add POLST questions to your states Minimum Data Set.
Description of Instrument: The Minimum Data Set is collected by all Medicare and Medicaid certified nursing homes in the United States. The data are clinical variables that assess each patient’s functional capacity, symptoms, diagnoses, treatments, and demographics. While there are a common set of variables collected by every state, there is a section, called Section S, where states are allowed to add variables that will be collected only in that State. In California, POLST advocates have been able to add questions about POLST to section S. In addition to being able to track how many nursing homes have POLST, their POLST orders, signer and Advance Directive information, investigators will be able to look at that information in the context of the comprehensive information contained in the Minimum Data Set and possibly link it to other databases such as Medicare. This will provide extraordinarily complex data about POLST utilization and how different POLST orders correlate with diagnoses, functional status, etc, etc. These data provide outstanding quality metrics in addition to research grade data.
How to use:
From listening to the National POLST Task Force attendees, getting questions added to your state’s Minimum Data Set may not be feasible in all states, and the process requires getting permission both from the correct state Department of Health & Human Services agency and the blessing of National Centers for Medicare and Medicaid Services. Many states do not utilize section S, which is generally used to do case mix adjustment-based reimbursement. Therefore states that are not currently using section S may automatically reject a request to add POLST questions because it would require additional resources.
At the February 14, 2013 meeting, it was proposed that these questions be added to the national Minimum Data Set. Some attendees raised the concern that nursing facilities would interpret the presence of the POLST questions as an indication that residents SHOULD have a POLST form and would begin offering them to residents who were not POLST appropriate, such as a younger patient rehabbing from orthopedic surgery. The decision was to wait until the California data were analyzed to see if this problem materialized before proceeding nationally.
If you are interested in exploring adding POLST questions to your state’s Minimum Data Set, I strongly encourage you to contact the National POLST Task Force Chair who can advise you and connect you with the appropriate contacts in California if necessary. Mailing Address: National POLST Paradigm Task Force, Oregon Health & Science University, Center for Ethics in Health Care, 3181 SW Sam Jackson Park Road, Mail Code: UHN-86, Portland, Oregon 97239. Phone: 503-494-3965. Fax: 503-494-1260