Pam EhrbarProgram Manager, Honoring Choices® Pacific Northwest

WE ARE PERFECTLY UNPREPAREDFOR 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.

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

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.

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

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

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

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

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 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

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%

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 RolloutKickoff 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 UsProgram Manager: Pam Ehrbar pam@honoringchoicespnw.org

WSHA: Carol Wagner carolw@wsha.org

WSMA: Jessica Martinson jessica@wsma.org

www.honoringchoicespnw.org

HonoringChoicesPNW@HCPacificNW