Gundersen Health System Leads the Way in Documenting Patients’ End-of-Life Wishes

Advance Care Planning (ACP) is an integral part of healthcare in La Crosse County, Wisconsin, where 96% of residents who die have documented end-of-life wishes, compared with 30% nationwide. La Crosse is home to Gundersen Health System, a leader in ACP whose approach has become culture across the region. For Gundersen patients, treatments during late-stage chronic disease and at the end of life align with their preferences almost without exception.

Bud Hammes, Ph.D., Gundersen’s ACP advocate, explains, “It isn’t just about training a few people to have these conversations with patients. It’s actually about changing the culture of the health care system and ultimately of the community.” Gundersen teaches healthcare providers and community leaders to help every adult decide what they want to happen if they become too ill or injured to make decisions. The approach encourages conversations among family members long before disease progression or sudden traumatic injury force caregivers to make difficult choices.

“Each one of us has a different interpretation of ‘quality of life’,” says Danielle Rathke, D.N.P., R.N., Gundersen’s ACP coordinator. “And our definition of acceptable quality can change as new circumstances arise. Helping patients talk about their goals, values, and preferences ultimately helps us know how to provide the best care.”

Patients’ advance directives are stored in Epic, which supports Gundersen’s entire ACP process with decision support, documentation forms, and follow-up tasks. Providers across the care continuum have access to ACP information, and managers regularly run reports to follow up with patients who haven’t documented their preferences for care.

Epic has worked with Gundersen to build standardized ACP tools that all community members can use and has made the specifics of their ACP processes available in their Clinical Program.

Read more about Gundersen’s approach to ACP conversations here.