Name of Project: Enhancing Communication for Improved End-of-Life Care
Institution: Henry Ford Health System, Detroit, MI
PI: Leslie J. Bricker, MD
Abstract (as described by Project staff)
Our goal is to design and implement an integrated communication plan that will bring excellence to end-of-life care. The two components of the project are an electronic advance directive and an interactive education CD-ROM for patients. Inherent in this process is education of the providers as well as patients that will empower individuals to be in control of their end-of-life decisions.
We will be providing an avenue in the health care system for patient’s advance directive preferences to be readily available on the electronic medical record. A new advance directive booklet and instruction video will enhance patient education. A planned education program for providers will increase the awareness of these components.
The patient care component will also include select patients having the opportunity to review the educative CD-ROM, Completing a Life. This education format will provide additional information for the patient and their families regarding end-of-life care, and will bridge communication with the provider.
Brief Synopsis of Program Characteristics, Successes and Challenges
Enhancing Communication for Improved End-of-Life Care is a project located at Henry Ford Health System (HFHS), one of the country’s largest vertically integrated systems that include hospitals and medical groups, as well as hospice, home health, long-term care and social work programs serving over 800,000 people in Southeast Michigan. Thanks to dedicated and persevering project staff (Leslie Bricker, MD, and Angela Lambing, RN), the overall goal of increasing communication about end of life decision-making was met. The project has two primary components: an advance directive initiative and interactive CD-ROM entitled Completing a Life.
Through the advance directive initiative, patients can create an advance directive upon hospital admission or at a clinic visit, aided by printed and video educational materials. At the heart of the AD initiative is a one-page, easily scanned form that becomes part of HFHS’s electronic medical record and, as such, is available to all clinicians with access to patient files.
“Completing a Life” is a CD-ROM developed at the Communications Technology Laboratory at Michigan State University under the direction of Dr. Karen Ogle. The CD-ROM is an interactive tool designed to assist patients and families through the end-of-life process. The initial target audience includes 150 oncology, infectious disease, nephrology and pulmonary patients identified by their primary care provider; ultimately, Completing a Life can be marketed to all patients. The CD will be provided to all clinicians in the Henry Ford system as a valuable tool for facilitating conversations with patients.
In addition to the advance directive initiative and the CD, Dr. Bricker has continued to offer monthly educational forums open to all providers. These lunchtime sessions are loosely based on EPEC and are approved for CME/CEU. Dr. Bricker has also adapted the monthly sessions into an abbreviated half-day symposium for clinicians unable to attend the ongoing training.
Exportable Products/Tools
Communications
Enhancing Communications for Improved End of Life Care is, at its core, a communications initiative. Its goal is to increase and improve communications about end of life, and to document those communications.
The project submitted a concept paper for the $15,000 communications grant available through the NPO that asked for support to disseminate “Completing a Life” to a broader audience, including medical and nursing school libraries, hospices and corporations.
Henry Ford Health System Web site is at www.henryfordhealth.org.
Internal Sustainability
When project staff was asked, “What will it take to sustain what you have learned?” they replied:
“Our new advance directive process will need to be part of our ongoing education processes as well as our quality improvement processes. In this way, it will continue to be reviewed and revised and allow growth.”
Generalizing the Model
Henry Ford’s Care Plus electronic medical record is truly state of the art. The advance directive component carries the potential for making advance care planning discussions between doctors and patients a routine feature of care. The availability of this crucial information immediately and across the large Henry Ford system can directly impact care, making it more consistent with patients’ values and goals. The advance directive form and format is not the only exportable product of this project. The CD also has the potential to reach audiences far beyond the large Henry Ford Health System. It is a valuable teaching tool for clinicians and, as such, should be marketed to health care students and professionals. It also has broad applicability for patients and families.
When project staff was asked what it would take to generalize what you have learned, they replied: “Within our system, there will be ongoing tutorial and education opportunities. Outside of our system, (generalization) will depend on the marketing of our electronic medical system by the institution, publications and presentations.”
Words of Wisdom from the Project
When project staff was asked, “Knowing what you know now, if another institution or project team in another community were to attempt a project similar to yours, what advice would you give them?” they replied:
“The importance of ‘champions’ who share the vision within your system cannot be underestimated. Champions at ‘all levels’ within the organization from highest executive, administrative staff, and medical leaders will ensure the buy-in and sustainability of the project. Protected time to devote to the project is essential. Establish a timeline/road map and review it constantly for changes. Be flexible and adaptable to changes that may occur within your system unexpectedly.”