Honoring Choices at Ridgeview Medical Center
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Honoring Choices at Ridgeview Medical Center
Sue DeGolier
July 19, 2012
About Ridgeview Medical Center
Distinguishing Features of Our Program
Established a dedicated Honoring Choices referral phone line
Hand chosen volunteer facilitators do an outstanding job
Model is financially sustainable and has capacity for growth
Comfort and convenience of the home setting for facilitation sessions is well received
Program Milestones
Pilot conducted January through June 2011
POLST form implemented in organization
Currently 14 RMC volunteers have completed facilitator training
Referral process for facilitations rolled out to all Ridgeview Clinics April 1, 2012
Several presentations have been done in the community to create awareness about Advance Care Planning
Soft roll-out regarding availability of facilitations for hospital and home care patients communicated to RMC social workers, July, 2012
Referrals
Rolled out to Ridgeview Clinics on 4-1-12
2.51.8
4.5
0
2
4
6
8
10
12
14
Jan-
11
Feb-
11
Mar
-11
Apr
-11
May
-11
Jun-
11
Jul-1
1
Aug
-11
Sep-
11
Oct
-11
Nov
-11
Dec
-11
Jan-
12
Feb-
12
Mar
-12
Apr
-12
May
-12
Jun-
12
Honoring Choices Referrals ReceivedJanuary 2011 - June 2012
Referrals Average Jan-Jun 2011 Average Jul-Dec 2011 Average Jan-Jun 2012
Contact Results and Outcomes
19
11
3
14
6
21
1614
0
5
10
15
20
25
Appt Scheduled Patient Declined Unable to Reach Pending (Unknown) Mailedor left formsw/patient,
or Patient wanted tocontact us later
Decision MakerIdentified
ACP Completed CopiesMailed/Distributed
Honoring Choices Referrals - Contact Results & OutcomesJanuary 2011 - June 2012
Total Referrals = 53
Measurement of ACPs in EMR
16
18
6
0
2
4
6
8
10
12
14
16
18
20
Adv. Directives Completed Copy of Adv. Dir. in Clinic EMR Copy of Adv. Dir. in Hospital EMR
Advance Directive Documents Scanned into Medical RecordJanuary 2011 - June 2012
Measurement of ACPs in EMR
Expirations with and ACP in EMR
at Time of Death, 44.8%
Expirations without an ACP in EMR at Time of Death, 55.2%
Expirations with/without an ACP in EMR at time of Death 2012
Total Expirations = 29Total Expirations with EMR = 13
Other Things We Measure
2119
8
3 20
5
10
15
20
25
Chanhassen Westonka Chanhassen Delano Hospital
Honoring Choices Referrals - Number of Referrals by SiteJanuary 2011 - June 2012
Total Referrals = 53
Other Things We Measure
0
2
4
6
8
10
12
Num
ber
of R
efer
rals
Honoring Choices Referrals - Patient Geographic LocationsJanuary 2011 - YTD 2012
Other Things We Measure
14.5
37.75
0
5
10
15
20
25
30
35
40
Volunteer Travel Hours Volunteer Facilitation Hours
Honoring Choices Referrals Volunteer Facilitator Time & Travel
January 2011 - June 2012
Other Things We Measure
0
500
1000
1500
2000
2500
3000
3500
Mar
-12
Apr-
12
May
-12
Jun-
12
Advance Directives-Patient Counts in HPFJanuary 2011 - June 2012
HPF -ADV Directive on File Y Pt has Adv. Directive (but no copy in HPF)
*Excluding Patients with Blank Advance Directive Type
Honoring Choices Referrals
Post Advance Care Planning Discussion Survey Results
Client Satisfaction Surveys given/received Data:
Level of satisfaction is rated 1(not at all) to 5 (very much)
1.) I feel that this discussion was helpful to me. 100% = 5 (very much)
2.) I feel better prepared to make decisions about my future health care.
100% = 5 (very much)
3.) I feel the facilitator did a good job of helping me with my needs for advance care planning.
100% = 5 (very much)
Surveys given = 12 Surveys Returned
= 7
Total number of referrals eligible for survey
Challenges
Monitoring resources and demand to assure enough facilitators and that volunteers are as busy as they want to be with facilitations
Cases may be open for a period of time
Some patients decline; need to develop a process for notifying referral source
We’ve received a limited number of survey responses
Not clear if ACP in record is a result of Honoring Choices
Variability in the level of engagement among Primary Care Providers
Next Steps
Develop measurement for staff time per referral (to contact facilitator, follow up on paperwork, etc.)
Develop a process for notifying referral source if patient declines
Develop plan for contacting people who have indicated they have an ACP, but copy is not in the medical record. Offer to review ACP with them or to do a facilitation; get copy into the medical record
To increase number of ACPs in the medical records at the clinic and the hospital will change the process to have facilitators bring original ACP to our office. We will make copies and mail/route
Since number of returned surveys is low, plan to change the process to have facilitators ask the client to fill out the survey and seal it in an envelope and hand it to the facilitator
Questions?
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