The National POLST Paradigm Task Force has updated its national map of POLST programs. Here are the definitions of the different statuses.
Mature status - the highest level of endorsement by the NPPTF is reserved solely for states with statewide POLST programs that, among other requirements are the standard preferred method of advance care planning for persons with advanced illness or frailty. Mature POLST programs are used by 50% or more of hospitals, nursing homes, and hospices in each region (as defined by established criteria such as EMS, Department of Health, or the Dartmouth Atlas) of the state. These programs are actively gathering data for quality assurance programs and have considered centralized POLST databases.
Endorsed - The NPPTF will endorse state POLST programs when they have developed and implemented a POLST program and form meeting the NPPTF standards. Endorsed programs are POLST programs that have become standard components of advance care planning in their location. These programs have addressed legal and regulatory issues associated with POLST, and have developed strategies for ongoing implementation and quality assurance.
Developing - Programs are recognized as “developing” when they have both: (1) submitted the Developing State Status Application form and (2) presented the state’s POLST form and progress to the NPPTF’s Developing State Assistance Committee (DSAC). Developing POLST Paradigm Programs may be at various stages of development, ranging from the initial design of a POLST form to active usage of POLST forms, but are working towards the goal of implementing the POLST program statewide. In general, programs at this step are starting to contemplate addressing all Seven Core Elements of Sustainability.
Nonconforming - Maryland legislation that went into effect in 2013 mandates the completion of POLST forms for certain patients. Their program violates the POLST Paradigm’s tenant that completion of a POLST is always voluntary. The current Massachusetts form does not include the “limited intervention” section that is the heart of POLST and where data documents the highest level of effectiveness but, instead, has a variety of questions. This lack of structure in the form causes confusion and lacks clarity and likely reduces effectiveness in honoring patient wishes. The current Vermont form is cumbersome and unclear, potentially causing confusion. It also incorporates elements of the state’s advance directive statute, mentioning the concept of futility with respect to the CPR/DNR order section.
No Program - When states are exploring the development of a regional or statewide POLST Paradigm program they can formally connect with the NPPTF. This level is for states not yet ready to complete the Developing POLST Paradigm documentation but who would like to participate in the National POLST Paradigm Program (e.g., receive emails from the national office, attend various education sessions put on by the National Office or the NPPTF, etc).
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