title: Initial Experience with "Honoring Choices Wisconsin": Implementation of an Advance Care Planning Pilot in a Tertiary Care Setting.
abstract: Although previous research on advance care planning (ACP) has associated ACP with improved quality of care at the end of life, the appropriate use of ACP remains limited.
  
  
  
  To evaluate the impact of a pilot program using the "Honoring Choices Wisconsin" (HCW) model for ACP in a tertiary care setting, and to understand barriers to system-wide implementation.
  
  
  
  Retrospective review of prospectively collected data.
  
  
  
  Patients who received medical or surgical oncology care at Froedtert and the Medical College of Wisconsin.
  
  
  
  Patient demographics, disease characteristics, patient satisfaction, and clinical outcomes.
  
  
  
  Data from 69 patients who died following the implementation of the HCW program were reviewed; 24 patients were enrolled in the HCW program while 45 were not. Patients enrolled in HCW were proportionally less likely to be admitted to the ICU (12.5% vs. 17.8%) and were more likely to be "do not resuscitate" (87.5% vs. 80.0%), as well as have a completed ACP (83.3% vs. 79.1%). Furthermore, admission to a hospice was also higher among patients who were enrolled in the HCW program (79.2% vs. 25.6%), with patients enrolled in HCW more likely to die in hospice (70.8% vs. 53.3%). The HCW program was favorably viewed by patients, patient caregivers, and healthcare providers.
  
  
  
  Implementation of a facilitator-based ACP care model was associated with fewer ICU admissions, and a higher use of hospice care. System-level changes are required to overcome barriers to ACP that limit patients from receiving end-of-life care in accordance with their preferences.
authors.affiliation: 1 Palliative Care Section , Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Peltier
authors.affiliation: 2 Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Faiz
authors.initials: F
authors.lastname: Gani
authors.affiliation: 3 Froedtert Hospital , Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blissitt
authors.affiliation: 3 Froedtert Hospital , Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Katherine
authors.initials: K
authors.lastname: Walczak
authors.affiliation: 3 Froedtert Hospital , Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kristi
authors.initials: K
authors.lastname: Opper
authors.affiliation: 4 Department of Emergency Medicine, Medical College of Wisconsin , Milwaukee, Wisconsin.
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Derse
authors.affiliation: 2 Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Fabian M
authors.initials: FM
authors.lastname: Johnston
mesh_terms: D032722:Advance Care Planning; D002755:Choice Behavior; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D010865:Pilot Projects; D015397:Program Evaluation; D012189:Retrospective Studies; D013727:Terminal Care; D062606:Tertiary Care Centers; D014922:Wisconsin
keywords: advanced care planning; advanced directive; end of life; palliative care; patient-centered