The Indiana POST (Physician Orders for Scope of Treatment) Program
About
The Indiana POST Program is designed for patients with advance chronic progressive disease, frailty, or terminal conditions. These are patients for whom the physician would not be surprised if they died within the next 12 months because of their advanced disease. Patients with these life-limiting conditions experience diminished benefits from treatments and increased burden as their condition progresses. The centerpiece of the program is the POST form, which documents patient treatment preferences if the form of medical orders that are easily understood by healthcare providers. The POST form is designed to transfer with patients throughout the healthcare system to ensure treatment preferences are honored across care settings. The Indiana POST Program is modeled after the POLST (Physician Orders for Life-Sustaining Treatment) Paradigm (www.polst.org), which has been implemented in 16 states and is in development in another 28 states. POST is not yet available in Indiana but efforts are underway to pass legislation making POST available to qualified patients.
History
The Indiana Patient Preferences Coalition (IPPC) is an organization of professionals in health care, ethics, law, and social and senior services that is committed to improving the tools and processes used to recognize and honor individual preferences for treatment in Indiana. IPPC intends to achieve this goal by developing a standardized tool to record patient preferences as medical orders that transfer across treatment settings. Since 2010, the IPPC has been working to secure support from community organizations, to develop program materials, and to draft proposed legislation for an Indiana POST Program.
HB 1115 was developed and introduced by Rep. Tim Brown, MD (R – Crawfordsville) in 2012 to establish the Indiana POST program. The IPPC has been working since that time to address questions about the bill and refine the legislation. A new draft of the legislation, House Bill 1182, will be introduced in the 2013 legislative session.
- 2013 POST Legislation – House Bill 1182
- 2013 Indiana POST form sample.pdf
- Indianapolis Medical Society Article on POST (reprinted with permission)
Research on POST
Although the POST Program was originally designed as a clinical innovation, research has been part of the POST program since its inception. Focus groups led to the initial development of a medical treatment coversheet1 and subsequent research led to revisions that simplified the language and format.2 The POST program is frequently used in the nursing facility and hospice setting.3-6 Emergency medical personnel report that the POST form is helpful in guiding treatment decisions.7 Unlike most traditional living wills, that the POST program alters the kind of treatments people receive near the end of life so that it is consistent with their preferences. Unlike traditional code status orders which narrowly focus on decisions about resuscitation, POST permits individualization of treatment goals to better reflect the myriad of decisions patients face in the last year of life.3-5 In a large, federally-funded multi-state study of POST form use in nursing facilities, residents with POST form orders were significantly more likely to have treatment preferences documented as orders in their medical records. Residents with POST form orders for comfort measures only were 67% less likely to be hospitalized than residents with orders for full treatment.6 Treatments provided were highly consistent with POST form orders for resuscitation (98%), medical interventions (92%), antibiotic use (93%) but less so for feeding tube use (64%).8
For additional information about POST research and complete references, go to http://www.ohsu.edu/polst/resources/research+references.htm.
1Dunn, Schmidt, Carley, Donius, Weinstein, & Dull (1996)
2Dunn, Nelson, Tolle, & Tilden (1997)
3Hickman, Tolle, Brummel-Smith, & Carley (2004)
4Hickman, Nelson, Moss, Hammes, Terwilliger, Jackson, & Tolle (2009)
5Hammes, Rooney, Gundrum, Hickman, & Hager (2012)
6Hickman, Nelson, Perrin, Moss, Hammes, & Tolle (2010)
7Schmidt, Hickman, Tolle, & Brooks (2004)
8Hickman, Nelson, Moss, Tolle, Perrin, & Hammes (2011)