Honoring Choices Qualis Health May 19, 2016
Qualis Health A leading national population health management organization The Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington The QIO Program One of the largest federal programs dedicated to improving health quality at the local level 2
Todays Content Learn about initiatives which exist in Washington and Idaho to assist providers, patients, and family members to engage in opportunities for advance care planning conversations Empower individuals to make and document decisions regarding wishes Have information consistent with their values and wishes Help providers ensure those health care choices are honored Increase awareness and understanding about the value of advance planning Help build the capacity to engage in these crucial conversations 3
Todays Format Presentations by leaders from each state followed by discussion with participants Questions and comments can be submitted in the Chat section Live discussion following the presentations Your feedback is important, please be interactive 4
Diane Pitchford, MSN, RN, CPHQ Director of Quality and Performance Improvement Washington State Hospital Association 999 Third Ave., Suite 1400 Seattle, WA 98104-4041 Phone: (206) 577-1820 Fax: 206-577-1915 dianep@wsha.org 5
Diane Pitchford, MSN, RN, CPHQ Director of Quality and Performance Improvement Washington State Hospital Association Faculty, Honoring Choices Pacific Northwest
Honoring Choices Pacific Northwest Vision Everyone in Washington will receive care that honors personal values and goals at the end of life.
Honoring Choices Pacific Northwest An initiative to inspire conversations about the care people want at the end of life. Health care organizations and community groups Discuss, record and honor end-of-life choices. Public Make informed choices about end-of-life care.
Why Advance Care Planning? 90% People say that talking with their loved ones about end-of-life care is important 27% Have actually done this 82% People say it s important to put their wishes in writing 23% Have actually done this 70% People prefer to die at home 70% People die in a long-term care facility or a hospital 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 hospice 10 days Fewer days spent in hospital during last two years if patient participated in advance care planning
Honoring Choices Pacific Northwest
Website: HonoringChoicesPNW.org Resources for the Public Start the Conversation Make a Plan Personal Stories Invite Family and Friends Resources for Professionals Research, Articles Conferences, Trainings
Advance Care Planning Program Guiding Principles Upstream conduct advance care planning with healthy adults, before an illness or a crisis Culturally sensitive adaptable to diverse communities Sustainable lasting infrastructure sustains initiative after roll-out Community based empower community to create culture change Alignment support and learn from what works well in Washington Standardization use evidence-based practices to standardize processes, while allowing for rapid cycle improvement Results oriented meaningful measures to demonstrate progress
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
Training Hierarchy and Sustainability
Culture Change Start the conversation Death isn t a taboo, but talking about how you want to die is Create systematic supports for change Shift from a system of completing an Advance Directive to a system of personcentered advance care planning
Quadruple Aim 16
Quadruple Aim Population Health/Better Outcomes: Integrates ACP throughout the community Increases hospice use at end of life Promotes timely and appropriate referrals for other needed services (palliative care, care coordination) Increases prevalence of planning in racially, ethnically, and culturally diverse communities Per Capita Cost: In the last two years of life, the average cost of care in La Crosse is $48,000 compared to $80,000 nationally The average number of inpatient days is 9.7 compared to 20.3 nationally 17
Quadruple Aim Patient Experience: Assists in providing care and treatment that is consistent with individual goals and values Results in high individual and family satisfaction Clinician Experience: Decreases moral distress of physicians and healthcare providers Increases professional satisfaction with a standardized approach to ACP Shifts time spent by physicians and healthcare teams on crisis end-of-life decision making to time spent on early and effective advance care planning 18
First Cohort Sites Across
First Cohort Capital Medical Center CHI Franciscan Health Confluence Health EvergreenHealth Group Health Cooperative Jefferson Healthcare Kadlec Regional Medical Center Kittitas Valley Healthcare Mason General Hospital MultiCare Health System Olympic Medical Center Overlake Medical Center PeaceHealth Providence Health & Services Pullman Regional Hospital Snoqualmie Valley Hospital District Summit Pacific Medical Center Swedish Health Services The Everett Clinic The Vancouver Clinic UW Medicine Health System Virginia Mason Medical Center Whitman Hospital and Medical Center
Timeline for Implementation Teams First Steps ACP Design & Implementation Course Teams develop and submit Implementation Plan w/faculty support Faculty review, edit and approve Implementation Plans Facilitator Certification Course Facilitator coaching and mentoring Implementation Period (6 months) Assess program and analyze results Instructor Certification Course "Share the Experience" Safe Table Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb 2016 2017
Statewide Implementation Timeline
How to Get Involved Email jessie.schwartz@honoringchoicespnw.org, carolw@wsha.org, or jessica@wsma.org Summer: Call for Statements of Interest ~30 new teams will launch this fall and attend training in February 2017 ~20 teams from currently participating organizations ~10 teams from new organizations
Contact Us info@honoringchoicespnw.org 206-577-1825 www.honoringchoicespnw.org @HCPacificNW HonoringChoicesPNW
Thank you!
Stephanie Bender-Kitz, Ph.D. Project Lead, Honoring Choices Idaho An initiative of Jannus 1607 W. Jefferson St. Boise, ID 83702 208.336.5533 ext. 255 / skitz@jannus.org www.jannus.org 26
May 19, 2016 Stephanie Bender-Kitz, Ph.D., Project Lead
Visionaries
Purpose Honoring Choices Idaho promotes opportunities for advance care planning conversations in the context of one s values, empowers individuals to make and document decisions, and helps ensure health care choices are honored.
Five Promises* 1. We will initiate the conversation. 2. We will provide assistance with advance care planning. 3. We will make sure plans are clear. 4. We will maintain and review plans. 5. We will appropriately follow plans. *Respecting Choices Copyright 2015 RC
Inspiring Conversations
Partner with us: *Build ACP into current services / supports *Train and certify facilitators and instructors *Increase awareness of ACP benefits *Help grow and sustain ACP
Imagine It is commonplace that every Idahoan develops an informed Advanced Care Plan before a health crisis occurs; those plans are always available to every Idaho health care provider; every health care setting honors those plans; and the essence of true personcentered care is achieved.
Get involved! Honoring Choices Idaho Project lead: Stephanie Bender-Kitz, Ph.D. skitz@honoringchoicesidaho.org 208.336.5533 ext. 255 Coming soon! www.honoringchoicesidaho.org
Questions, Comments and Discussion 36
Opportunities for Improvement and Collaboration
What would You be able to do to further this conversation? Is this important to your organization? What are you currently doing? Are there opportunities for working together within your organization or across your community? How could we help you with these efforts? 38
Take Home Points There is certainly room for improvement in becoming aware of our patients wishes Resources and opportunities are available to us in both states We can all be leaders individually as well as organizationally to facilitate conversations and action 39
Thanks and Appreciation Thanks so much to our speakers for sharing their expertise with us and to all of you for your attention and contribution. Our Qualis Health contact information is on the next slide, along with the site for a brief survey that will appear following the webinar; we truly appreciate your feedback and comments! 40
Contact Carol Higgins, OTR (Ret), CPHQ Quality Improvement Consultant carolh@qualishealth.org (206)288-2454 Martha Jaworski, MS, RN, CIC Quality Improvement Consultant marthaj@qualishealth.org (208)383-5944 For survey: https://www.surveymonkey.com/r/sqrdjfz For more information: http://medicare.qualishealth.org/projects/care-transitions This material was prepared by Qualis Health, the Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. ID/WA-C3-QH-2376-05-16 41