Pam Ehrbar Program Manager, Honoring Choices ® Pacific Northwest

WE ARE PERFECTLY UNPREPARED FOR SOMETHING TOTALLY PREDICTABLE

Honoring Choices ® Pacific Northwest Vision Everyone in Washington will receive care that honors personal values and goals at the end of life.

8.8 the increased likelihood of a person having prolonged grief if their loved one dies in an ICU compared to home with hospice 5 the increased likelihood of a person having PTSD if their loved one dies in an ICU compared to home with hospice 10 the number of fewer days patients spend in the hospital during their last two years if they’ve participated in advance care planning 6,900 the amount saved by patients who receive palliative care vs hospital care Why Advance Care Planning? 60%Don’t want to burden their families with tough decisions at the end of their life 56%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 hospice 10 daysFewer 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

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.

Website Promote conversations with family, loved ones and physicians about what is important at the end of life. Advance Care Planning Program Prepare health care organizations and communities to discuss, record and honor individuals’ choices about end of life care. Honoring Choices ® Pacific Northwest

Resources for the Public Start the Conversation Make a Plan Personal Stories Invite Family and Friends Resources for Professionals Research, Articles Conferences, Trainings

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.

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

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

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

Engage Respect Institute for Healthcare Improvement “Conversation Ready” Principles Steward

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

Proven Outcomes Improves 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

Proven Outcomes In 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%

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

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

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

“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

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.

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

Honoring Choices ® PNW Rollout Kickoff in October 2015

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

“Life is pleasant. Death is peaceful. It's the transition that's troublesome.” ~Isaac Asimov

Thank you!

Contact Us Program Manager: Pam Ehrbar WSHA: Carol Wagner WSMA: Jessica Martinson