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
Honoring Choices Referrals Received
January 2011 - June 2012
14
12
10
8
6
4
4.5
2
1.8
2.5
Jun-12
May-12
Apr-12
Mar-12
Feb-12
Jan-12
Dec-11
Nov-11
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
Apr-11
Mar-11
Feb-11
Jan-11
0
Rolled out to
Ridgeview Clinics on 4-1-12
Referrals
Average Jan-Jun 2011
Average Jul-Dec 2011
Average Jan-Jun 2012
Contact Results and Outcomes
Honoring Choices Referrals - Contact Results & Outcomes
January 2011 - June 2012
25
20
21
19
15
16
14
10
14
11
5
6
3
0
Appt Scheduled
Patient Declined
Total Referrals = 53
Unable to Reach
Pending
(Unknown) Mailed
or left forms
w/patient,
or Patient wanted to
contact us later
Decision Maker
Identified
ACP Completed
Copies
Mailed/Distributed
Measurement of ACPs in EMR
Advance Directive Documents Scanned into Medical Record
January 2011 - June 2012
20
18
18
16
16
14
12
10
8
6
6
4
2
0
Adv. Directives Completed
Copy of Adv. Dir. in Clinic EMR
Copy of Adv. Dir. in Hospital EMR
Measurement of ACPs in EMR
Expirations with/without an ACP in EMR at time of
Death 2012
Expirations
without an ACP
in EMR at Time
of Death, 55.2%
Total Expirations = 29
Total Expirations with EMR = 13
Expirations with
and ACP in EMR
at Time of
Death, 44.8%
Other Things We Measure
Honoring Choices Referrals - Number of Referrals by Site
January 2011 - June 2012
25
20
21
19
15
10
8
5
3
2
Delano
Hospital
0
Chanhassen
Total Referrals = 53
Westonka
Chanhassen
Other Things We Measure
Honoring Choices Referrals - Patient Geographic Locations
January 2011 - YTD 2012
12
Number of Referrals
10
8
6
4
2
0
Other Things We Measure
Honoring Choices Referrals
Volunteer Facilitator Time & Travel
January 2011 - June 2012
40
37.75
35
30
25
20
15
14.5
10
5
0
Volunteer Travel Hours
Volunteer Facilitation Hours
Other Things We Measure
Advance Directives-Patient Counts in HPF
January 2011 - June 2012
3500
3000
2500
2000
1500
1000
500
HPF -ADV Directive on File
*Excluding Patients with Blank Advance Directive Type
Y Pt has Adv. Directive (but no copy in HPF)
Jun-12
May-12
Apr-12
Mar-12
0
Honoring Choices Referrals
Post Advance Care Planning Discussion Survey Results
Client Satisfaction Surveys
given/received
Data:
Surveys given = 12
Surveys Returned = 7
Total number of referrals eligible for survey
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 100% = 5 (very much)
my needs for advance care planning.
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?