Honoring Choices at Ridgeview Medical Center

Sue DeGolier

July 19, 2012

About Ridgeview Medical Center

Distinguishing Features of Our Program

Established a dedicated Honoring Choices referral phone line

Hand chosen volunteer facilitators do an outstanding job

Model is financially sustainable and has capacity for growth

Comfort and convenience of the home setting for facilitation sessions is well received

Program Milestones

Pilot conducted January through June 2011

POLST form implemented in organization

Currently 14 RMC volunteers have completed facilitator training

Referral process for facilitations rolled out to all Ridgeview Clinics April 1, 2012

Several presentations have been done in the community to create awareness about Advance Care Planning

Soft roll-out regarding availability of facilitations for hospital and home care patients communicated to RMC social workers, July, 2012

Referrals

Rolled out to Ridgeview Clinics on 4-1-12

2.51.8

4.5

0

2

4

6

8

10

12

14

Jan-

11

Feb-

11

Mar

-11

Apr

-11

May

-11

Jun-

11

Jul-1

1

Aug

-11

Sep-

11

Oct

-11

Nov

-11

Dec

-11

Jan-

12

Feb-

12

Mar

-12

Apr

-12

May

-12

Jun-

12

Honoring Choices Referrals ReceivedJanuary 2011 - June 2012

Referrals Average Jan-Jun 2011 Average Jul-Dec 2011 Average Jan-Jun 2012

Contact Results and Outcomes

19

11

3

14

6

21

1614

0

5

10

15

20

25

Appt Scheduled Patient Declined Unable to Reach Pending (Unknown) Mailedor left formsw/patient,

or Patient wanted tocontact us later

Decision MakerIdentified

ACP Completed CopiesMailed/Distributed

Honoring Choices Referrals - Contact Results & OutcomesJanuary 2011 - June 2012

Total Referrals = 53

Measurement of ACPs in EMR

16

18

6

0

2

4

6

8

10

12

14

16

18

20

Adv. Directives Completed Copy of Adv. Dir. in Clinic EMR Copy of Adv. Dir. in Hospital EMR

Advance Directive Documents Scanned into Medical RecordJanuary 2011 - June 2012

Measurement of ACPs in EMR

Expirations with and ACP in EMR

at Time of Death, 44.8%

Expirations without an ACP in EMR at Time of Death, 55.2%

Expirations with/without an ACP in EMR at time of Death 2012

Total Expirations = 29Total Expirations with EMR = 13

Other Things We Measure

2119

8

3 20

5

10

15

20

25

Chanhassen Westonka Chanhassen Delano Hospital

Honoring Choices Referrals - Number of Referrals by SiteJanuary 2011 - June 2012

Total Referrals = 53

Other Things We Measure

0

2

4

6

8

10

12

Num

ber

of R

efer

rals

Honoring Choices Referrals - Patient Geographic LocationsJanuary 2011 - YTD 2012

Other Things We Measure

14.5

37.75

0

5

10

15

20

25

30

35

40

Volunteer Travel Hours Volunteer Facilitation Hours

Honoring Choices Referrals Volunteer Facilitator Time & Travel

January 2011 - June 2012

Other Things We Measure

0

500

1000

1500

2000

2500

3000

3500

Mar

-12

Apr-

12

May

-12

Jun-

12

Advance Directives-Patient Counts in HPFJanuary 2011 - June 2012

HPF -ADV Directive on File Y Pt has Adv. Directive (but no copy in HPF)

*Excluding Patients with Blank Advance Directive Type

Honoring Choices Referrals

Post Advance Care Planning Discussion Survey Results

Client Satisfaction Surveys given/received Data:

Level of satisfaction is rated 1(not at all) to 5 (very much)

1.) I feel that this discussion was helpful to me. 100% = 5 (very much)

2.) I feel better prepared to make decisions about my future health care.

100% = 5 (very much)

3.) I feel the facilitator did a good job of helping me with my needs for advance care planning.

100% = 5 (very much)

Surveys given = 12 Surveys Returned

= 7

Total number of referrals eligible for survey

Challenges

Monitoring resources and demand to assure enough facilitators and that volunteers are as busy as they want to be with facilitations

Cases may be open for a period of time

Some patients decline; need to develop a process for notifying referral source

We’ve received a limited number of survey responses

Not clear if ACP in record is a result of Honoring Choices

Variability in the level of engagement among Primary Care Providers

Next Steps

Develop measurement for staff time per referral (to contact facilitator, follow up on paperwork, etc.)

Develop a process for notifying referral source if patient declines

Develop plan for contacting people who have indicated they have an ACP, but copy is not in the medical record. Offer to review ACP with them or to do a facilitation; get copy into the medical record

To increase number of ACPs in the medical records at the clinic and the hospital will change the process to have facilitators bring original ACP to our office. We will make copies and mail/route

Since number of returned surveys is low, plan to change the process to have facilitators ask the client to fill out the survey and seal it in an envelope and hand it to the facilitator

Questions?