1. Honoring Choices Tennessee
AdvanceDirectivesTN.org
Sally Pitt, Office of Patient Care Advocacy

2. WE ARE PERFECTLY UNPREPARED FOR SOMETHING TOTALLY PREDICTABLE
Source: Pam Ehrbar Program Manager, Honoring Choices ® Pacific Northwest

3. Honoring Choices Tennessee
An Advance Directive is… a written statement of a person's wishes regarding medical treatment, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.

4. Honoring Choices Tennessee
An Advance Directive is… a written statement of a person's wishes regarding medical treatment, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.

5. Honoring Choices Tennessee
A group of interested individuals and organizations across Tennessee have come together under the name Honoring Choices  Tennessee to make it easy for Tennesseans of every age to create their own advance directive--simply, conveniently and without expense.
Tennessee Advance Directives Initiative
Formed late 2015
Research and Planning 2016
Targeted Public Launch early 2017
© 2016 Phil Martin Affiliates, Inc.

6. Honoring Choices Tennessee
Vision
Every Tennessean discusses and completes an Advance Directive.
Goal
Increase the number of Tennesseans who have a conversation about Advance Directives, who complete an advance directive and who choose to direct their own end of life care.
Focus Areas:
Engagement
Education
System Infrastructure
Continuous Quality Improvement

7. Honoring Choices Tennessee
AdvanceDirectivesTN Initiative
Developed an advance care planning education program for health care employees to increase their understanding of advance directives. Developed to equip and educate health care employees to have meaningful conversations with their patients about advance directives.
Website
Online links and resources to advance care planning resources for individuals and health care providers.

8. Honoring Choices Tennessee
Tennessee Advance Directives Initiative

9. Why are Advance Care Planning Conversations Important?
Conversations matter
90% of people say that talking with their loved ones about future health care decisions is important
Only 27% actually have
Source: Why Conversations Matter. (2016, April 25). Retrieved from

10. Why are Advance Care Planning Conversations Important?
Conversations matter
People are ready for Advance Care Planning conversations
89% of people say they would want to discuss end of life care issues with their doctor
Only 17% report having had this conversation with their doctor
Source: (Kaiser Family Foundation Health Tracking Poll, Sept 2015)

11. Conversations Matter in Tennessee
33% Less than one third of adult Tennesseans say they have an advance directive.   86% Tennesseans over 65 believe they have an advance directive of some kind.   82% Tennesseans ages do not have an advance directive.   45% Among core working-age Tennesseans (ages 30 to 65), say they do not have an advance directive.
Source: 2016 Tennessee Advance Directives Initiative research

12. Healthcare Cost Healthcare Cost
One out of every four Medicare dollars--$125 billion--covers care for people near the very end of their life. 30% of Medicare expenditures are attributed to the 5% of beneficiaries who die each year. 1/3 of those costs--over $12 billion--are incurred in the last month of life.
Sources: Time and Forbes
© 2016 Phil Martin Affiliates, Inc.

13. Quality of Life Quality of Life
The average hospital stay for patients without advance directives is three times greater than those who have an advance directive.
Sources: Medicare Patient Study (Chambers, Diamond, Perkel
© 2016 Phil Martin Affiliates, Inc.

14. Effectiveness of Advance Care Planning
A systematic review of Advance Care Planning ( ACP) that included over one hundred papers, consisting of predominately observational studies found:
Increased compliance with patients’ end of life wishes ( three out of four studies).
A decrease in subsequent hospitalizations ( three out of three studies).
APC increased quality of life for patients ( four out of four studies)
The presence of a Do Not Resuscitate ( DNR) order was associated with a decreased use of cardiopulmonary resuscitation ( CPR, four out of five studies) and an increased use of hospice and palliative care services ( six out of six studies).
Source:Brinkman-Stoppelenburg A, Rietjens JA, van der Heide A.
The effects of advance care planning on end-of-life care: a systematic review. Palliat Med 2014; 28:1000.

15. AdvanceDirectivesTN Initiative
Move the conversation upstream and provide clear direction…
A statewide partnership of regional and statewide organizations, state agencies, and individuals working together to promote advance care planning.
An initiative to education health care employees about advance care planning to:
Encourage discussion of advance directives
Consider completing an advance directive to document their choices
Share their completed document with their family members and health care provider
Equip them with knowledge of the importance of advance directives to start the conversation with their patients
Ensure documented values and preferences are honored at the point of care across the entire lifespan.

16. AdvanceDirectivesTN Initiative
Phase 1:
Health care organizations
a. Encourage healthcare employees understand what Advance Care Planning and Advance Directives are and why they are important in honoring choices
b. Encourage employees who do not already have their own advance directives to consider:
i. Having a conversation with their family and friends regarding
the end-of-life care they would like to receive
ii. Executing an advance directive for themselves and sharing with their healthcare provider
c Prepare employees to explain advance directives to others in a clinical setting
[ patients, other providers, family members, etc.]
d Add an advance directive education component to new employee orientation program
e Track and report the following data quarterly:
i. The number of educational training sessions conducted, number of participants at each training session, and the number of completed documents as a result of activity

17. The Ask The Ask… Organizations: Honoring Choices Tennessee:
Senior management buy-in and local champions
Identify an implementation team
Organization- wide events
Nominal out-of-pocket expense
Sustain program to roll-out advance care planning to patients using established teams
Implement own quality improvement process
Add a link from organization’s website to
Honoring Choices Tennessee:
Toolkit, training, webinars and support
Train the trainer instructors and facilitators

18. AdvanceDirectivesTN Initiative
The Launch:
April 17, 2017: Implemented a “pilot” program in Northeast Tennessee, Mountain States Health Alliance
Educate and equip 4,000 employees
Employee benefit fairs (10 locations)
Train-the-trainer ( social workers, chaplains, case managers, and other health care professionals)
Pocket size advance directive form
Later in the year, five additional hospitals will implement the Advance DirectivesTN Initiative

19. AdvanceDirectivesTN to “Change their Story.”
Maybe it’s time to encourage your team
to “Change their Story.”
© 2016 Phil Martin Affiliates, Inc.

20. AdvanceDirectivesTN about what matters most to them.
It simply starts with a conversation
about what matters most to them.
© 2016 Phil Martin Affiliates, Inc.

21. AdvanceDirectivesTN
During your health benefits renewal process, ask your employees if they have an advance directive.
© 2016 Phil Martin Affiliates, Inc.

22. AdvanceDirectivesTN
If they don’t have an advance directive, encourage them to go to and create one.

25. Honoring Choices Tennessee
“Receiving care that honors individual values and having the opportunity to talk and make informed decisions about end of life care depends so much on the recording and sharing of these documents with family and others given access, like health providers; this is the way Honoring Choices can make some of our last and most important wishes come true." Tennessee Commissioner of Health John Dreyzehner, MD, MPH, FACOEM April 17, 2017

26. Contact Information
Thank you!
Sally Pitt
Tennessee Department of Health
Office of Patient Care Advocacy
710 James Robertson Parkway
Nashville, TN  37243