healthpartners targeted approach for advance directives
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HealthPartners Targeted Approach for Advance Directives. Honoring Choices Conference July 18, 2013 Christine Sylvester, Care Delivery Supervisor Kate Kellett, Regional Clinic Director. Advance care planning is a spectrum of decisions. based on patient preference and disease complexity. - PowerPoint PPT PresentationTRANSCRIPT
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
• [email protected]• 952.541.2614
– Christine Sylvester, Care Delivery Supervisor• [email protected]• 651.254.7516