Wisconsin Cancer Control Summit presentation: Honoring Choices: Building the Conversation about Advance Care Planning

1. It’s about the conversation Wisconsin Cancer Control Summit presentation: Honoring Choices: Building the Conversation about Advance Care Planning in WI March 29, 2012 Sue Schettle, Chief Executive Officer, Twin Cities Medical Society

2. Documentary clip

3. Project Leaders • Twin Cities Medical Society • 5,500 physician members • 7 county St. Paul/Minneapolis metro area • Population is diverse: 2.7 million in metro; 5.3 million in the state • Our role • Convener, coordinator, catalys

4. To promote the benefits and implement processes and methods of advance care planning to the community at large Mission

5. Honoring Choices Minnesota is… • Respecting Choices concepts, methodologies, training systems and materials (Gundersen Lutheran, La Crosse, WI) • Minnesota-based health care directive, governance and implementation

6. The Process A facilitated process Advance care planning A patient directed document Health care directive Provider orders used to translate patient’s wishes to medical instructions POLST

7. Determining interest • August 2008 – Exploratory community member meeting • Unanimous support. • Sept 2008 – Senior leadership meeting • Unanimous support • Strong collaboration • “We can’t do this alone”

8. Honoring Choices Minnesota • Phase 1: Building health care infrastructure • Phase 2: Community Engagement • Phase 3: Evaluation

9. Building health care infrastructure • Late 2008 – collaborative initiated; • 2009 – Advisory Committee formed; • health care directive developed, based on Allina and Park Nicollet documents, • 2010 – Pilot sites began, partnerships formed, grant funding obtained to support next phase Phase 1:Building health care infrastructure

10. Allina Hospitals & Clinics Blue Cross & Blue Shield MN East Metro Medical Society Foundation Fairview Health Services HealthEast Care System HealthPartners Hennepin County Medical Center Minnesota Network for Hospice and Palliative Care Institute for Clinical Systems Improvement (ICSI) Living at Home / Block Nurses – Merriam Park Medica Minnesota Academy of Family Physicians North Memorial Health Care Park Nicollet Health Services Stratis Health Twin Cities Medical Society UCare Advisory Committee Phase 1:Building health care infrastructure

11. Health care directive • Appoints agent/surrogate • Document detailing your desires for future health care decisions, in case you are unable to speak for yourself • 5 languages • FREE; download at www.metrodoctors.com Phase 1:Building health care infrastructure

12. Citizens League listening session findings • Tremendous power in sharing stories • Family conversations are most important aspect to end of life planning • Advance directives make people feel better prepared • Strong motivation to protect one’s family from having to guess Phase 1:Building health care infrastructure

13. Citizens League listening session findings • Mixed view and experiences about physicians and medical profession • Are physicians listening? • Religious teachings are important • More involvement desired of faith based leadership to organize conversations and help people reflect Phase 1:Building health care infrastructure

14. Pilot sites form • We identified participants • We organized Respecting Choices trainings: • Institutional readiness conferences • Facilitator training courses • Instructor training courses • We helped pilot sites to: • Form their pilot teams • Develop their work flow Phase 1:Building health care infrastructure

15. Components of a pilot site • Hospitals, clinics, long term care facilities • Organizational commitment to: • Devote organizational resources to the pilot • Train staff in Respecting Choices program • Facilitators, Instructors • Utilize Minnesota based forms • Capture consistent quality measures • Participate in monthly meetings; report findings Phase 1:Building health care infrastructure

16. Early adopters emerge • Allina Hospitals and Clinics • 11 hospitals • 18 months • Park Nicollet Health Services • 1 hospital • 1 year Phase 1:Building health care infrastructure

17. 2010 Pilot Sites • Hennepin County Medical Center • HealthEast Care System • HealthPartners • Fairview Eagan & Rosemount Clinics • Fairview Oxboro Clinic • Fairview Red Wing Medical Center • Fairview Ridges Hospital Phase 1:Building health care infrastructure

18. 2011 Pilot Sites • Lakeview Hospital • North Memorial Medical Center • Queen of Peace Hospital • Redeemer Health and Rehab Center • Ridgeview Medical Center Phase 1:Building health care infrastructure

19. 2012 Pilot Sites • Presbyterian Homes • Thrivent Financial for Lutherans (employer) • CentraCare • 6 communities in Minnesota Phase 1:Building health care infrastructure

20. Education: 2009-2013 • Utilizing Respecting Choices curriculum • Honoring Choices MN has trained: • 800+ facilitators • 32 instructors • 40 multicultural and community Ambassadors trained and activated Phase 1:Building health care infrastructure

21. System-wide implementation • Allina Hospitals & Clinics • 11 hospitals • Fairview Health Services • 5 hospitals • Park Nicollet • 1 hospital Phase 1:Building health care infrastructure

22. Patient Education Materials Translated in 5 languages • Somali, Hmong, English, Spanish, Russian • Used system wide in • 11 Hospitals • 1 faith based organization • More on the horizon

23. Focus for 2012-2013 • Continue building health care infrastructure • More pilot sites (will look different) • Outside of the Twin Cities metro • Develop physician education program • Promote patient education materials • Activate multicultural advisory committee Phase 1:Building health care infrastructure

24. Honoring Choices Minnesota • Phase 1: Building health care infrastructure • Phase 2: Community Engagement • Phase 3: Evaluation

25. Outreach • Many community presentations (examples): • Evangelical summit; seminaries; synagogues; churches • AARP tele-town hall (20,000 people); state fair • Many partnerships forming • Minnesota Council of Churches partnership • Multi-cultural groups, religious, non-traditional families, legal community, etc. • Multicultural Advisory Committee formed • 13 Citizens League listening sessions held Phase 2: Community Engagement

26. Feature article in Sunday Star Tribune (Sunday distribution: 518,095) 6 documentaries on Twin Cities Public Television (multiple airings) Website: www.honoringchoices.org PSAs… who would speak for you? Book released end of February Media and Print Phase 2: Community Engagement

27. 2011 -2013 Focus • Broadening community engagement • Ambassadors move into community • More “events” • More documentaries • More evaluation measurements Phase 2: Community Engagement

28. Honoring Choices Minnesota • Phase 1: Building health care infrastructure • Phase 2: Community Engagement • Phase 3: Evaluation

29. Evaluation Phase 3: Evaluation

30. Allina data • 12,695 staff/providers trained in advance care planning education and training • # of patients with documented advance care planning discussions • 2010 – 5,000; 2011 – 14,000 • 37% hospitalized patients with scanned health care directive • 27% clinic patients with scanned health care directive

31. Questions? Honoring Choices Minnesota – it’s about the conversation

32. Contact Information • Sue Schettle Project Director; 612-362-3799 Chief Executive Officer, Twin Cities Medical Society sschettle@metrodoctors.com