1. CARE MORE…COST LESS Health Action Committee www.greatersudburyhac.com
October, 2016

2. Health Action Committee .. Who are we?
16 Sudbury citizens 54-79, with various backgrounds
We are Community Minded
Health Care Experience… We all have had a story to tell
Many cared for frail, elderly family members
Our Collective Knowledge/skills …
has contributed to Patient Centered Solutions
United in belief that More Care ..can cost LESS…
LESS Suffering to patients and families and
Better use of our Money invested into our health care system
16 Sudbury citizens 54-79, from diverse backgrounds e.g. business, education, health care, government, communications, labour
Committed to community, some having been born here, others long time residents
All have had involvement with health care system personally, and/or through friends and/or family
Many cared for frail, elderly family members
Collective knowledge, skills, stories and experience to contribute to patient-centred solutions
United in belief that care can cost less..less suffering to patients and families, less money to health care system
CARE MORE..
COST LESS

3. Shift the focus from disease to patient…
Currently medicine in Canada is focused on disease and system needs, not patient needs
Shift the focus from disease to patient…
Currently medicine in Canada is focused on disease and system needs, not patient needs
CARE MORE..
COST LESS

4. Shift the focus from disease to patient…
Ontario’s Action Plan…..What is their current position?
Elderly patients are more complex!
Physicians/other health care providers.. Delivery of Info?
When all of the key players don’t communicate as a whole.. What are the ramifications?
Ontario’s Action Plan for health care says it’s time to adjust and integrate the system to patient’s needs
Many patients, especially elderly, are medically complex, frail, beset with serious co-morbidities
Physicians and other health care providers do not always give the patient all information and do not always talk to each other
When care professionals do not confer among one another, and don’t give patients all information and opportunity to choose care, unwanted aggressive care can result in loss of ability to live independently, loss of cognitive function, and distress for patients and family
CARE MORE..
COST LESS

5. Joan’s Story Joan’s history with Cancer Her prognosis
Health professionals training is about….?
All Joan wanted was a peaceful End Of Life
Joan’s journey to her personal Cancer therapy
Information Void led to…..?
MRI initiated.. BUT when?
No Hospice for Joan meant…?
Friends make a difference BUT…?
Joan was forty-something, had battled cancer in teens, thirties, when cancer recurred
Evidence overwhelming that she wouldn’t survive
Health professionals trained, “to prolong life, attempt to cure, never give up”
Joan had deficits from previous treatments, lived alone, and wanted a peaceful death in hospice
Joan was not given all information, Joan was not given a choice, and sadly chemotherapy initiated
She reported increasing pain and symptoms, but it was not until she insisted on MRI, that full extent of disease acknowledged, too late to get into hospice
Entered hospital expressing fear of dying alone and of uncontrolled pain
Friends made sure she had constant company, but the roster of rotating hospitalists didn’t effectively manage her pain until her last hours
CARE MORE..
COST LESS

6. British Medical Journal: Advance Care Planning
What Have We Learned?
Trained facilitators identified patients’ wishes about end-of-life care
Conversations focused on values, giving patient all available information, in supportive environment to decide own treatment plan
Approach decreased unwanted investigations, interventions, treatments, admissions
Approach improved care and diminished stress, anxiety and depression in surviving relatives
Decreased costs
What Have We Learned
British Medical Journal, 2010:
Trained facilitators identified patients’ wishes about end-of-life care
Conversations focused on values, giving patient all available information, in supportive environment to decide own treatment plan
Approach decreased unwanted investigations, interventions, treatments, admissions
Approach improved care and diminished stress, anxiety and depression in surviving relatives
Decreased costs
CARE MORE..
COST LESS

7. We Can Do Better: Advance Care Planning
coordinated, systematic model of care
where patients and families are given all information by trained professionals and
given the opportunity to make informed choices about their own care
“Advance Care Planning”..a coordinated, systematic model of care where patients and families are given all information by trained professionals, and given the opportunity to make informed choices about their own care
British Medical Journal, 2010:
Trained facilitators identified patients’ wishes about end-of-life care
Conversations focused on values, giving patient all available information, in supportive environment to decide own treatment plan
Approach decreased unwanted investigations, interventions, treatments, admissions
Approach improved care and diminished stress, anxiety and depression in surviving relatives
Decreased costs
CARE MORE..
COST LESS

8. We Can Do Better: Advance Care Planning
MOHLTC data suggest up to 25% health care spending in last year of life
Approximately $10 billion in Ontario alone
2009 study on final week of life -Two groups had comparable survival time
Patients who reported end-of life-discussions with physicians
had less physical distress in final week and cost of care was 35.7% lower
MOHLTC data suggest up to 25% health care spending in last year of life
Approximately $10 billion in Ontario alone
2009 study monetized differences in health care use for advanced cancer patients in final week of life who had end-of-life discussions with physicians vs those who did not
Two groups had comparable survival time
Patients who reported end-of life-discussions with physicians had less physical distress in final week and cost of care was 35.7% lower
CARE MORE..
COST LESS

9. Testing Advance Care Planning
What is happening at Health Sciences North?
Physicians in Halifax developed a successful model of Advance Care Planning
As has Australia
What happened when Coordinators with skills and empathy took over?
Currently a one unit at Health Sciences North is running a test of Advance Care Planning “Goals of Care”
Physicians in Halifax developed a successful model of Advance Care Planning as has Australia
As a parallel, Ontario’s organ donation rate rose from 10 to 70% when coordinators with training, skill and empathy took over dialogue with families of donors
Ontario’s organ donation rate rose from 10 to 70%
CARE MORE..
COST LESS

10. Designate Sudbury’s system to test Advance Care Planning (ACP)
Make ACP and goals of care a key component of care for ALL..
patients who are medically complex, frail and have multiple conditions
Patient’s circle of care …WHO…WHAT…WHEN?
ACP can be a powerful Tool for
System Integration
Patient Experience
HAC believes this to be the best approach.. Research/experience supports this
We believe Sudbury is ready NOW!…
Let’s make it happen…NOW!
Make advance care planning and goals of care key component of care of all patients who are medically complex, frail and have multiple conditions
Make available to all providers in patient’s circle of care, and update regularly
Once widely available, such a plan would be a powerful tool for system integration, focusing as it does on a planned, consistent patient experience across the system
Research and personal experience of HAC members support this approach
Sudbury is ready…let’s make it happen…now!
CARE MORE..
COST LESS