1. The New World of Palliative Care State of Reform Conference Jan 8, 2015 By Cynthia Tomik, MSW, LICSW Manager: Palliative Care & Your Home Primary Care, EvergreenHealth

2. Today’s objectives Using patient stories: Review: Palliative care/Advance care planning Discuss: Importance of PC/ACP Highlight: Importance of having programmatic structure in place (with adequately trained professionals) Present EvergreenHealth Palliative Care model

3. Patient Story 89 y/o female w Dementia, hx of renal disease Living in ALF. POLST (DNR) on file with ALF DPOA is daughter (who is a med-surg nurse) Son is attorney. Family discord re GOC No comfort meds on board Crisis on Friday: 2 days of no intake/output DPOA does not want hospitalization, Son unsure, ALF concerned about liability – No documented ACP

4. Patient Story 41 y/o mother of 2 young children Breast cancer Stage 4 Doesn’t want to “give up”. Fighting And growing concern about quality of life No clear directives/advance care planning No designated DPOA (not married/lives with father of children, parents out of state) Uncontrolled pain

5. Palliative Care Philosophical ideal meets operations Palliative Care and Advance Care Planning Consultations and community education Separating palliative care from end of life care Limited resources Finances/revenue

6. What is Palliative Care? Specialized medical care for people with serious illnesses. Focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. Definition from www.cacp.org

7. Palliative Care

8. EvergreenHealth Home Care Services Serves patients in Snohomish and King Counties. Services include: Home Health Hospice Palliative Care Behavioral Health In Home Primary Care Services

9. EvergreenHealth Palliative Care Community-based (since 2006) LICSW/anywhere Sno/King Hospital/Inpatient (since 3/2013) MD/EHMC Kirkland/RN/MSW support Outpatient/office based (since 2/2014) MD/EHMC campus/LICSW support

10. EvergreenHealth Palliative Care Weekly IDT Shared resources with Pulmonary (clinic) and Oncology (inpatient) Use of ACP Decisions video (Volandes) Presentations to Primary/Specialty Clinics Public presentations (Senior Centers/ALF/etc) Advance Care Planning classes (Pulmonary Rehab/Cancer Lifeline/etc) www.acpdecisions.org

11. Metrics % patients who have advanced care plan documented in EMR % visits with documented pain assessment (standardized tool) and documented follow up plan Response to ACP videos Referrals % YHPC patients utilizing PC

12. Resources National Hospice &PC Org: http://www.nhpco.org/http://www.nhpco.org/ WA State Hospice & PC Org: http://www.wshpco.org/http://www.wshpco.org/ Center to Advance PC: http://www.capc.org/http://www.capc.org/ American Academy of Hospice and Palliative Medicine (AAHPM) http://aahpm.org/ http://aahpm.org/ Honoring Choices Pacific NW: http://www.honoringchoicespnw.org/http://www.honoringchoicespnw.org/ The Robert Bree Collaborative End-of-Life Report http://www.breecollaborative.org/topic-areas/eol/ http://www.breecollaborative.org/topic-areas/eol/ Washington End-of-Life Coalition http://www.wsma.org/wcm/Patients/Washington_End_of_Life_Consensu s_Coalition.aspx http://www.wsma.org/wcm/Patients/Washington_End_of_Life_Consensu s_Coalition.aspx Washington POLST https://www.wsma.org/wcm/Patients/POLST.aspxhttps://www.wsma.org/wcm/Patients/POLST.aspx Cambia Palliative Care Center of Excellence at UW http://depts.washington.edu/pallcntr/ http://depts.washington.edu/pallcntr/