healthpartners targeted approach for advance directives

HealthPartners Targeted Approach for Advance Directives

Honoring Choices ConferenceJuly 18, 2013

Christine Sylvester, Care Delivery SupervisorKate Kellett, Regional Clinic Director

• Advance care planning is a spectrum of decisions.

based on patient preference and disease complexity.

• This work is part of HealthPartners enterprise-wide

end of life care improvement activity.

Honoring Choices

Targeted

Honoring Choices

Targeted Simple

- Targeted > 65- Mild chronic

conditions

Simple

Self Directed Educate

Well Mild/ Disease Multiple/Complex Severe/Complex

Advance Care PlanningTarget Appropriate Patients

Background• Why was the advance directive short form created?

– HealthPartners committed to deploying Honoring Choices approach.

– Deployment to primary care was not successful (no targeting).

– Patients often not open to a facilitated intense advance care planning conversation.

• Form “too long”• Patients wanted simpler document for first interaction

– HP needed a SYSTEM WIDE approach for ALL 26 clinics. – The completion/return rate of Honoring Choices form was

low when piloted.– Based on the patient’s preference, the clinic will offer

either the one-page document or the Honoring Choices document.

Honoring Choices Form/Process TARGETING METHODOLOGY

•Multiple severe chronic disease•Specialty focus

– Cardiology (CHF) – Nephrology ( Kidney Failure) – Oncology (Metastatic Cancer) – Pulmonary (COPD) – Neurology (Dementia, Parkinsons)

•Nursing home/Assisted living•Complex frail MSHO•Palliative Care

Elements of Form

• Name a person to designate your wishes should you be unable to communicate these decisions. A secondary agent (health care proxy) is optional in the event the primary agent is unavailable.THIS IS CRITICAL first step for many patients.

• Choose your particular wishes about efforts to revive you if needed due to no pulse/no breathing.

Elements of Form • Include other wishes if desired. May include

religious beliefs, plans for funeral arrangements, donation of organs, any strong value or belief you want known.

• Have a notary sign this. Can be done by notaries in the clinic. Can be done by other notaries (bank, etc.)

• Reception staff will give or mail copies, the form will be scanned into EPIC and documented on the problem list.

Primary Care Clinic Flow

EPIC format – Problem List & Administrative Tab for LOCATION of info

Primary Care Clinic Flow

Clinic Trainings

• Nursing leaders and Nurse Practitioner provided training to every primary care clinic

• One-hour lunch and learn session with webinar option for those who could not attend in person

• Workflow reviewed every six months through bi-annual standard work training

• Well received!

Outcome

↑ 1,791 patients

Primary Care Patients (65 and Older) with Advance Directive in EPIC

Next Step

• Frail/Elderly Care model process to target complex

primary care patients to Honoring Choices process

• Continued attention to 5 key specialties for Honoring

Choices

• Further learning with our Multicultural populations

• When patients condition changes – Honoring Choices

can be instituted (re- assess decisions)

Resources

• Facilitator Hotline

• Notary Public in every clinic

• Honoring Choices & POLST form also used in primary

care, specialty and hospital

• HealthPartners Website is a resource- Forms and

Information

Questions

• For more information…– Kate Kellett, Regional Clinic Director

• Katherine.m.kellett@healthpartners.com• 952.541.2614

– Christine Sylvester, Care Delivery Supervisor• Christine.m.sylvester@healthpartners.com• 651.254.7516