HealthPartners Overview of End-of-Life Care

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HealthPartners Overview of End-of-Life Care
Advance Care Planning

• Honoring Choices Minnesota
• July 19, 2012

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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
HOME CARE, GERIATRICS, HOSPICE PALLIATIVE CARE
REGIONS
HEALTH PLAN
PRIMARY CARE
SPECIALTY CARE
COMMUNITY

• Jim Risser, MD
• Beth Heinz
• Danielle Tencate Cole

• Lora Heidin
• Karen Kraemer

• Kate Kellet

• Terry Carter
• Tyler Schmidtz
• Rachel Nygard

• Mary Lou Irvine
• Tom von Sternberg, MD
• Beth Werner

• Mary Lou Irvine
• Tom von Sternberg, MD
• Donna Zimmerman
• Beth Heinz

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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

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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

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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

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Hospice, Palliative Care Adv Care Planning
Referrals Disease Case Management
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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.

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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.

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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

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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.

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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

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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

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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

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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

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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

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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

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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

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Community

• Honoring Choices Minnesota
• CEO and Senior Leadership support
• Member of Advisory Committee
• Ambassador Program participation (Kate Kellet
  with primary)

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HealthPartners End of Life/Palliative Care
Initiatives
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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