HealthPartners Targeted Approach
for Advance Directives
Honoring Choices Conference
July 18, 2013
Christine Sylvester, Care Delivery Supervisor
Kate Kellett, Regional Clinic Director
• Advance care planning is a spectrum of decisions.
based on patient preference and disease complexity.
• This work is part of HealthPartners enterprise-wide
end of life care improvement activity.
Advance Care Planning
Target Appropriate Patients
Honoring Choices
Targeted
Honoring Choices
Targeted
Simple
Self Directed
Educate
Well
Simple
- Targeted > 65
- Mild chronic
conditions
Mild/ Disease Multiple/Complex Severe/Complex
Background
• Why was the advance directive short form created?
– HealthPartners committed to deploying Honoring Choices
approach.
– Deployment to primary care was not successful (no
targeting).
– Patients often not open to a facilitated intense advance
care planning conversation.
• Form “too long”
• Patients wanted simpler document for first interaction
– HP needed a SYSTEM WIDE approach for ALL 26 clinics.
– The completion/return rate of Honoring Choices form was
low when piloted.
– Based on the patient’s preference, the clinic will offer
either the one-page document or the Honoring Choices
document.
Honoring Choices Form/Process
TARGETING METHODOLOGY
• Multiple severe chronic disease
• Specialty focus
– Cardiology (CHF)
– Nephrology ( Kidney Failure)
– Oncology (Metastatic Cancer)
– Pulmonary (COPD)
– Neurology (Dementia, Parkinsons)
• Nursing home/Assisted living
• Complex frail MSHO
• Palliative Care
Elements of Form
• Name a person to designate your wishes should you
be unable to communicate these decisions. A
secondary agent (health care proxy) is optional in the
event the primary agent is unavailable.
THIS IS CRITICAL first step for many patients.
• Choose your particular wishes about efforts to revive
you if needed due to no pulse/no breathing.
Elements of Form
• Include other wishes if desired. May include
religious beliefs, plans for funeral arrangements,
donation of organs, any strong value or belief you
want known.
• Have a notary sign this. Can be done by notaries in
the clinic. Can be done by other notaries (bank, etc.)
• Reception staff will give or mail copies, the form will
be scanned into EPIC and documented on the
problem list.
Primary Care Clinic Flow
Health Maintenance
Alert in EPIC – 65 and
older
• Advance directive offered
to patients seeing their
primary care provider
• One-page form
presented with the
option to use Honoring
Choices form
Rooming Nurse &
Provider
Clinic Assistant
(Receptionist)
• Nurse will identify
patients who do not have
advance directive on file
• Presents advance
directive information to
patient during rooming
process
• Provider encourages
completion of advance
directive and answers
questions
• Offers notary if needed
• Verifies advance directive
is signed and completed
• Scans advance directive
into patient’s chart
• Provides patient with 3
copies
EPIC format – Problem List & Administrative Tab for LOCATION of info
Primary Care Clinic Flow
Clinic Trainings
• Nursing leaders and Nurse Practitioner provided
training to every primary care clinic
• One-hour lunch and learn session with webinar
option for those who could not attend in person
• Workflow reviewed every six months through
bi-annual standard work training
• Well received!
Outcome
Primary Care Patients (65 and Older) with Advance Directive in EPIC
↑ 1,791 patients
Next Step
• Frail/Elderly Care model process to target complex
primary care patients to Honoring Choices process
• Continued attention to 5 key specialties for Honoring
Choices
• Further learning with our Multicultural populations
• When patients condition changes – Honoring Choices
can be instituted (re- assess decisions)
Resources
• Facilitator Hotline
• Notary Public in every clinic
• Honoring Choices & POLST form also used in primary
care, specialty and hospital
• HealthPartners Website is a resource- Forms and
Information
Questions
• For more information…
– Kate Kellett, Regional Clinic Director
• Katherine.m.kellett@healthpartners.com
• 952.541.2614
– Christine Sylvester, Care Delivery Supervisor
• Christine.m.sylvester@healthpartners.com
• 651.254.7516