Transcript HealthPartners

HealthPartners Overview of
End-of-Life Care & Advance Care Planning
Honoring Choices Minnesota
July 19, 2012
End of Life/Palliative Care Steering Committee
Co-chairs: Tom von Sternberg, MD, Beth Waterman
Membership includes representatives from Regions Hospital,
Specialty Care, HealthPartners Home Care, Geriatrics,
Hospice & Palliative Care, Primary Care and the Health Plan
Areas of Focus:
REGIONS
-Jim Risser, MD
-Beth Heinz
-Danielle
Tencate Cole
HEALTH
PLAN
-Lora Heidin
-Karen Kraemer
PRIMARY
CARE
-Kate Kellet
SPECIALTY
CARE
HOME CARE,
GERIATRICS,
HOSPICE &
PALLIATIVE CARE
-Terry Carter
-Tyler Schmidtz
-Rachel Nygard
-Mary Lou Irvine
-Tom von Sternberg, MD
-Beth Werner
COMMUNITY
-Mary Lou Irvine
-Tom von Sternberg, MD
-Donna Zimmerman
-Beth Heinz
Regions
Palliative Care referrals
• Criteria in Epic
• Auto referral for Medical ICU patients over 85
• Surgical ICU will add auto referral
• Presence at care rounds
• Expanding to Emergency Dept: Physician Orders for Life
Sustaining Treatment (POLST) and consults
• Increasing Palliative Care provider coverage
• Partnership with oncology Nurse Practitioner
Regions Palliative Care
Consults / 1,000 Discharges
90
80
70
60
50
40
30
20
10
0
Jan-09
Apr-09
Jul-09
Oct-09
Jan-10
Apr-10
Jul-10
Oct-10
Jan-11
Apr-11
Jul-11
Oct-11
Jan-12
Apr-12
Regions
Advance Directives
• Using the Honoring Choices and POLST forms
• 56% of patients 65+ have Advance Directives
(1/11-2/12)
• Lean project
– Design workflows to obtain Advance Directives and ensure copy is available in
Epic
– Interdisciplinary effort (Palliative Care, Hospital Medicine, Nurse, Care
Management, Chaplaincy, HIM)
– Comprehensive review of current process, identification of potential barriers,
and ideas for new models
– Early fall 2012 goal for implementation
Health Plan
Disease & Case Management
• Staff training and awareness resulted in increased
referrals for Palliative Care, Advance Care Planning
and Hospice
• Advance Directive measure: 8543 patients screened,
3262 completed
• EBAN project successes spread to all patients/members
Hospice, Palliative Care & Adv Care Planning Referrals
Disease & Case Management
2,100
217
1,800
705
1,500
1,200
319
900
171
56
225
600
882
300
521
64
112
0
67
2009
2010
2011
Total
243
973
2,123
Hospice Referrals
64
171
217
56
705
Advance Care Planning Referrals*
Palliative Referrals
112
225
319
In-hospital Hospice Collaborations**
67
521
882
EBAN Experience
• Eban is a letter from the Asanti people of Ghana. It
represents security, safety and trust. It was chosen
as the symbol of the EBAN Experience to represent
the coming together of cultures to improve the
health of all.
EBAN Experience
• Adopted by HealthPartners as an organizational
initiative for addressing health disparities and
equitable care in 2011.
• The EBAN Experience is a year-long collaborative of
teams created to address issues of health disparities
in the communities served by HealthPartners.
• Creative strategies that partner health care
professionals and community members.
EBAN Experience
• Areas of focus include:
– Increased rates of advance directives
– Increased pediatric immunization rates
– Improve diabetes health outcomes through
education
• Results
– Improved the rate of completed Advance
Directives in the MSHO African-American
population from 25% to 32% by year end.
– Narrowed the disparity gap between Whites and
African Americans from 25% to 21%
Health Plan
• HealthPartners.com
• Current information in Health and Wellness tab in
“Additional Resources”
Future Plans:
• New “Care-giving Health Center” in Health &
Wellness tab will provide information on advance
care planning, shared decision making, etc.
Primary Care
Advance Directives
• Workflow is with care team, with Epic prompt and
notary
• Pilots at Riverside, Brooklyn Center, Como, West for
patients 65+
• Using short form with brochure and/or Honoring
Choices form
• Expanding to all locations in 9/12 and then to
younger population, i.e, 50 and over
• Staff Education
Specialty Care
Oncology
• Sharing NP resource with Regions Palliative Care
• Population: new diagnosis, pancreatic and lung
cancer, any stage 3 and 4
• Facilitated conversations with nurse practitioner or
social worker
• Measure: since 1/11, 701 (23%) of all cancer
patients have Advance Directives in EPIC
Specialty Care
Regions Heart Center
• Population: Heart Failure Class II, III, IV
• Providers initiate conversation then RN “facilitator”
meets with patient
• Measure: 83.5% of Class III and IV, 45% of Class II
have Advance Directives
Specialty Care
Nephrology
• Population: Chronic Kidney Disease stage 4, 5
• Provider initiates conversation then RN facilitation or
Advance Care Directives Class (group session),
follow-up phone call
Beginning work: Pulmonary
Future work: Neurology
Geriatrics, Home Care, Hospice
Geriatrics/Home Care
• Standardized workflow, documents and where to
locate in EPIC.
• Measure: 75% with Advance Directives documented
• Increased long term care facility adoption of POLST
Geriatrics, Home Care, Hospice
Palliative Care/Hospice
• Facilitated discussion with admission
• Hospice measure: 960 of 1000 patients in 2011
completed POLST
• Palliative Care measure: 273 admissions in 2011
with 227 completed Advance Directives using
Honoring Choices Minnesota document
• Coordinating with inpatient Palliative Care consult
team and weekly rounding
Community
• Alliance of Community Health Plans (ACHP) Palliative
Care workgroup
• National Quality Forum (NQF) Hospice workgroup
• Institute for Healthcare Improvement (IHI): The
Conversation Project by Ellen Goodman
• EPIC and Health Information Exchange
• End of Life training course with Jim Risser, MD and
Richard Heinrich, MD (2 days, twice a year)
• St. Paul Area Council of Churches
• EBAN project
Community
Honoring Choices Minnesota
• CEO and Senior Leadership support
• Member of Advisory Committee
• Ambassador Program participation (Kate Kellet with
primary)
HealthPartners
End of Life/Palliative Care Initiatives
REGIONS
Jim Risser MD, Beth
Heinz, Danielle
TencateCole
• Inpatient and ED
Palliative Care
consult
• Outpatient
resources for
consults
o Oncology clinic
partnership
• Focus for FIT
Quality team
• LEAN project:
Advance Directives
• Measuring patient
anxiety and pain
HEALTHPLAN
Lora Hedin, Karen
Kraemer
• Palliative Care
benefit
oCommercial
oMSHO
• Care and Disease
Management
o Spreading
learnings from
EBAN project
o Referrals to
Palliative Care,
Advance Care
Planning,
Hospice
• HealthPartners.com
PRIMARY
CARE
Kate Kellet
• Advance Directive
workflow
oShort form,
brochure and/or
Honoring
Choices form
oFacilitator
available
oPilots at
Riverside,
Brooklyn Center,
West, Como; to
all sites 9/12
• Epic “prompt” on
health maintenance
screen
• Population Health
workflow
component
SPECIALTY
CARE
GERATRICS,
HOME CARE
& HOSPICE
Terry Carter, Dave
Slowinske, Tyler Schmidtz,
Rachel Nygard
Mary Lou Irvine, Tom
von Sternberg MD, Beth
Werner
• Cardiology CHF patients
class II, III and IV
oHonoring choices
form and facilitator
• Oncology
oNew cancer
diagnosis patient
identified in previsit planning
oFocus on
pancreatic, lung and
any Stage 3 and 4
cancers
oHonoring choices
form and facilitator
• Nephrology
oChronic Kidney
Disease patientsstage 4 and 5
identified in previsit planning
oHonoring Choices
form, facilitator or
Advance Care
Directives class
• Cardiology CHF AllCollaboration with
hospice and palliative
care
oPulmonary
oNeurology
• Geriatrics/Home
Care
oHonoring
choices or
POLST form
oStandardized
workflow for
EPIC or out of
system
providers and
homecare EMR
oNursing home
adoption of
POLST form
• Palliative
Care/Hospice
oFacilitated
discussion on
advance care
planning at
admission
oHonoring
choices or
POLST form
oCoordination
with inpatient
palliative care
consult team
COMMUNITY
Mary Lou Irvine, Tom
von Sternberg MD,
Donna Zimmerman,
Beth Heinz
• ICSI Workgroup
• ACHP Palliative
Care workgroup
• HIE/EPIC
• Honoring Choices
MN
oAmbassador
program
oPublic television
• EBAN project
• St Paul area Council
of Churches
Challenges/Opportunities
• Meeting cultural needs of patients
• EPIC modification that meets needs of community
• Limitation with Palliative Care benefit
• Improving website location and accessibility
(HealthPartners.com and My Partner)
• Building awareness
• Incorporating into Employee Wellness Program