Honoring Choices Minnesota: Preliminary Data from a Community‐Wide Advance Care Planning Model

Abstract

Advance care planning (ACP) increases the likelihood that individuals who are dying receive the care that they prefer. It also reduces depression and anxiety in family members and increases family satisfaction with the process of care. Honoring Choices Minnesota is an ACP program based on the Respecting Choices model of La Crosse, Wisconsin. The objective of this report is to describe the process, which began in 2008, of implementing Honoring Choices Minnesota in a large, diverse metropolitan area. All eight large healthcare systems in the metropolitan area agreed to participate in the project, and as of April 30, 2013, the proportion of hospitalized individuals 65 and older with advance care directives in the electronic medical record was 12.1% to 65.6%. The proportion of outpatients aged 65 and older was 11.6% to 31.7%. Organizations that had sponsored recruitment initiatives had the highest proportions of records containing healthcare directives. It was concluded that it is possible to reduce redundancy by recruiting all healthcare systems in a metropolitan area to endorse the same ACP model, although significantly increasing the proportion of individuals with a healthcare directive in their medical record requires a campaign with recruitment of organizations and individuals.

Improving the Electronic Capture of Advance Care Directives in a Healthcare Delivery System

“…In contrast to these studies, which evaluated decedents, the current study evaluated all patients aged 65 and older with a clinic visit. A recent study describing a community‐wide AD initiative demonstrated 11.6–31.7% AD capture rate in outpatients aged 65 and older at eight institutions . The current study was concordant with this capture rate among living individuals.…”

“…A recent study describing a community-wide AD initiative demonstrated 11.6-31.7% AD capture rate in outpatients aged 65 and older at eight institutions. 6 The current study was concordant with this capture rate among living individuals.…”

“…Previous studies evaluating advance care planning included a successful community‐wide intervention in the Midwest that achieved 85% AD documentation rates in decedents. This model is being scaled to other communities but requires substantial financial investment and extensive facilitator training, which limits its potential use …”

“…This model is being scaled to other communities but requires substantial financial investment and extensive facilitator training, which limits its potential use. [6][7][8] Rationale The Institute of Medicine described the Life Cycle Model as an effective, evidence-based framework to address advance care planning. Under this framework, all should have an opportunity to actively participate in healthcare decision-making throughout their lives, including advance care planning for care at the end of life, when many do not have the capacity to make their own decisions.…”

“Well-Being in All Policies”: Promoting Cross-Sectoral Collaboration to Improve People’s Lives

“…HealthPartners leaders are accountable to the board of directors for progress toward nonclinical goals just as they have traditionally been accountable for clinical care goals. Program examples include child-focused activities promoting healthful nutrition and physical activity (43–45), an advance care planning initiative to increase well-being at end of life (46), and a multisectoral campaign to eliminate stigma surrounding mental illness (47). HealthPartners is active in urban initiatives supporting education and health (48) and recently launched a 10-component Children’s Health Initiative with a goal of improving children’s health and well-being from birth through age 5 (49).…”