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Trenton Health Team Launches Community-Wide Palliative Care Initiative

Medical Experts from Area Hospitals Collaborate to Help Patients Manage Discomfort from Chronic Disease and Make End of Life Plans

TRENTON, NJ — The Trenton Health Team is educating area physicians about how to help patients relieve and prevent the discomfort and debilitation caused by chronic disease from the diagnosis through the end of life, a healthcare focus otherwise known as palliative care. In an unprecedented collaboration driven by THT, palliative care experts from each of the hospitals in Trenton and Hamilton Township recently joined forces to discuss how they could bring their services out of the hospital and into the community.

Trenton residents, like many other people living in cities, tend to suffer from a number of chronic diseases like HIV, cancer, kidney failure, heart disease and diabetes. Faced with challenges of poverty and lack of access to quality food, they are more vulnerable to diseases that last years, if not a lifetime. As a disease progresses over a patient’s lifetime, palliative care can reduce suffering and improve quality of life.

“Through collaboration and conversation, we discovered the need to develop palliative care resources in Trenton that physicians and patients can use outside the hospital setting,” said Dr. Robert Remstein, the president of the Trenton Health Team and vice president for Accountable Care at Capital Health, one of two hospitals which anchor the THT. “The first step is to educate physicians about palliative care, including end of life care.”

One key area of focus for the palliative care initiative is a form called POLST (Practitioner Orders for Life-Sustaining Treatment) that physicians and other healthcare providers can use to help seriously ill and frail elderly patients plan for end of life care. Late last week N.J. Health Commissioner Mary O’Dowd unveiled the POLST form and a statewide program to empower individuals to make decisions regarding their medical care at the end of life. THT’s palliative care program is supportive of the state agency’s efforts to work with healthcare professionals. It is providing physicians and nurses with education about POLST that will also address broader palliative care in the community.

The first THT-sponsored POLST seminar was hosted by St. Francis Medical Center, the other THT hospital anchor, earlier this month. The education session was led by Dr. David Barile, executive director of N.J. Goals of Care, a non-profit organization dedicated to improving medical decision-making for seniors. More than 100 physicians and nurses from throughout Mercer County attended the program, which provided continuing medical education (CME) credits to attendees.

“Dr. Barile’s lecture was an exceptional educational experience for clinicians. They welcomed the NJ’s POLST form because it provides a guide for discussions with their patients, and it begins with the patient’s treatment and quality of life goals,” said Christy Stephenson, treasurer of THT and executive vice president for strategy at St. Francis.

Dr. Ruth Perry, executive director of the THT, added, “We will be working with healthcare providers to give the necessary training and tools to have this critically important discussion with patients and their families. Patient-centered care is an important component of healthcare transformation. This changes the paradigm of the traditional provider-patient relationship to one of partnership and collaboration. It is the conversation between the provider and the patient that is crucial. The provider must work with the patients and their families to help them understand the course of their illnesses, and the patients need to help the provider understand their needs and concerns so that the patient’s goals and desires inform all stages of the treatment plan.”

A number of states have developed POLST-style guidelines in recognition that seriously ill patients were receiving treatments inconsistent with their wishes, even when patients had legal documents outlining those wishes. The POLST form becomes part of a patient’s permanent medical record, so it is valid in all medical settings.

Some of THT’s POLST and palliative care education sessions will target doctors who treat high risk patient populations but who do not already routinely provide this type of care. The sessions will be offered to nursing home physicians, pulmonologists, cardiologists and nephrologists-doctors treating patients in the six THT Trenton zip codes who are in the later stages of chronic disease or at the end of life.

“In developing community-wide palliative care, we are creating a service that patients can use outside of the hospital to manage the symptoms of chronic disease, and a consultative service to physicians, helping where the doctor may not be comfortable talking about end of life care,” said Dr. Remstein.

THT’s subgroup on community-wide palliative care currently has about 15 members from the medical community who have decided to meet regularly to further develop their ideas and plans for implementation. They now intend to invite members of the faith community to join the discussion.

THT expects the group to expand to include members from other community organizations as well. While this type of collaboration is unprecedented in the nation’s healthcare system, it is representative of THT’s overall collaborative approach to improving healthcare.

About the Trenton Health Team
Trenton Health Team (THT) is an alliance of the city’s major providers of healthcare services including Capital Health, St. Francis Medical Center, Henry J. Austin Health Center and the city’s Health Department. In collaboration with residents and the city’s active social services network, THT is developing an integrated healthcare delivery system to transform the city’s fragmented primary care system and restore health to the city. THT aims to make Trenton the healthiest city in the state. The THT receives generous support from The Nicholson Foundation, corporate partners and other foundations. For more information, visit