Pam Ehrbar Program Manager, Honoring Choices ® Pacific Northwest.
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Transcript of Pam Ehrbar Program Manager, Honoring Choices ® Pacific Northwest.
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Pam EhrbarProgram Manager, Honoring Choices® Pacific Northwest
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WE ARE PERFECTLY UNPREPAREDFOR SOMETHING TOTALLY PREDICTABLE
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Honoring Choices® Pacific Northwest
Vision
Everyone in Washington will receive care that honors
personal values and goals at the end of life.
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Why Advance Care Planning?
60% Don’t want to burden their families with tough decisions at the end of their life56% Have not communicated their end-of-life wishes
8.8x Increased likelihood of prolonged grief if loved one dies in ICU vs. home with hospice
5x Increased likelihood of PTSD if loved one dies in ICU vs. home with hospice10 days Fewer days spent in hospital during last two years if patient participated
in advance care planning
70% Prefer to die at home
70% Die in a hospital or long-term care facility
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Honoring Choices® Pacific Northwest
An initiative to inspire conversations about the care people want at the end of life.
Public
Make informed choices about health care options.
Health care organizations and community groups
Discuss, record and honor health care choices.
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WebsitePromote conversations with family, loved ones and physicians about what is important at the end of life.
Advance Care Planning ProgramPrepare health care organizations and communities to discuss, record and honor individuals’ choices about end of life care.
Honoring Choices® Pacific Northwest
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Resources for the Public
• Start the Conversation
• Make a Plan
• Personal Stories
• Invite Family and Friends
Resources for Professionals
• Research, Articles
• Conferences, Trainings
www.HonoringChoicesPNW.org
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Advance Care Planning Program
Goal: Prepare organizations to discuss, record and honor individuals’ choices about end-of-life care.
Strategy: Deliver a multi-phased, sustainable advance care planning implementation program to health care organizations and communities across the state.
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Guiding Principles• Upstream – move the conversation upstream and provide clear direction
• Culturally sensitive – adaptable to diverse communities
• Sustainable – continue to provide resources after the initial rollout
• Alignment – complement current programs in Washington
• Standardization – use evidence-based program to standardize processes
• Results oriented – meaningful measures
Advance Care Planning Program
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Advance Care Planning Program
• Based on Gundersen model– Internationally recognized evidence-based program
• Advance Care Planning should be: – an ongoing process of communication
– reviewed and updated regularly
– integrated into routine, patient-centered, preventive care
– appropriately staged to the individual’s state of health
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Advance Care Planning Program
• Organizational Requirements:- Identify administrative and physician champions- Establish an implementation team- Participate in 12 months implementation- Participate in system-wide and community-wide spread
• Honoring Choices Pacific Northwest Provides:- Training, materials, webinars, monthly cohort consulting- Certify Respecting Choices Instructors and Facilitators- Ongoing faculty support and learning collaborative
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Engage
Engage
Respect
Institute for Healthcare Improvement “Conversation Ready” Principles
Steward
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Using National Best Practices
• Gundersen model: Internationally recognized
evidence-based program
• Coordinated, systematic, person-centered advance
care planning program
• High quality care and reduction in healthcare costs
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Proven OutcomesImproves Patient Care
• Improves clinician competency and comfort level with advance care
planning conversations
• Provides specific guidance in making clinical decisions as patients
live with advanced illness
Improves Population Health
• Decreases moral distress of healthcare providers and clinicians
working with patient and surrogate end-of-life decision making
• Shifts time spent by providers on crisis end-of-life decision making
to time spent on early and effective advance care planning
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Proven OutcomesIn the last two years of life:
• At Gundersen: Average cost of care is $48,000.
– Nationally: Average is close to $80,000.
• At Gundersen: Average number of inpatient days: 10
– Nationally: Average is 16.7 days.
Reduces unwanted hospitalizations
• At Gundersen: Percent hospitalized at least once during last six
months of life: 60%
– Nationally: 71.5%
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Program Sustainability
• Certified faculty, instructors and facilitators
• Train teams in all communities across the state
• Established teams will have the experts and resources in-house to work within their organizations to roll-out advance care planning to other departments
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Proven Outcomes
Medical expenditures in last two years of life:
• At Gundersen, the average cost of care is $48,000.
– The national average is close to $80,000.
• At Gundersen, the average number of inpatient days is 9.7
– The national average is 20.3 inpatient days.
Advance Directives:
• 96 percent of people who die in La Crosse have an advance
directive or similar documentation
– Nationally, only about 25 percent of adults have an advance directive
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Proven Outcomes
Advance Directives
• 96% of people who die in La Crosse, WI have an advance directive
– Nationally: About 25% of adults have an advance directive
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“Making a plan is just like taking
blood pressure or doing allergy tests.
It's just become part of good care here.”
~Bud Hammes, Gundersen Health System
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Population Health Improvements
• Clarify patient goals of care by exploring the concept of “living well.”
• Standardizes the delivery of advance care planning.
• Decreases moral distress of healthcare providers and clinicians.
• Promotes timely and appropriate referrals for other needed services.
• Shifts time spent by physician and healthcare team on crisis end-of-life decision making to time spent on early and effective advance care planning.
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Using a proven method in an innovative way
• Gundersen has:
– 20-year history
– Strong track record of successful roll-outs across the US and
other countries
• Washington state model draws on:
– power of the collaborative
– learnings from other roll-outs
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Honoring Choices® PNW RolloutKickoff in October 2015
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Homework
• Read Atul Gawande’s book
– Frontline episode
• Exemplify in your own life
– Start the conversation with your loved ones
– Complete your advance directive
– Encourage your professional colleagues to start the
conversation
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“Life is pleasant. Death is peaceful.
It's the transition that's troublesome.”~Isaac Asimov
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Thank you!
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Contact UsProgram Manager: Pam Ehrbar [email protected]
WSHA: Carol Wagner [email protected]
WSMA: Jessica Martinson [email protected]
www.honoringchoicespnw.org
HonoringChoicesPNW@HCPacificNW