Fellowship spotlight: Promoting Advance Care Planning and Advance Directives for Wisconsin's People – Breanna Palmen

Medical College of Wisconsin-Milwaukee medical student Breanna Palmen recently provided an update on her research with mentor George M. Lange, MD, on Promoting Advance Care Planning (ACP) and Advance Directives for Wisconsin's People. The goal of the research was to gain a better understanding of baseline utilization of advance directives and to determine the best practices and cost effectiveness in promoting advance directives. Breanna first became interested in this topic as a Certified Nursing Assistant in an Intensive Care Unit in Kenosha where often patients’ wishes were unknown and families faced terrible burdens to make informed decisions. In Wisconsin, fewer than half of adults have done advance care planning. This project provided evidence-based information from an extensive literature review.

There are multiple facets to the underuse/under completion of ACP; one factor is the influence of patient demographics on ACP completion. Many studies cite that gender, education, marital status, age and socio-economic status can all influence ACP completion rates. Another factor is the difference between ACP completion rates among different health systems. One study cited completion rate among facilities varied from 0% to 98%. There are notable areas in Wisconsin, such as the La Crosse and Appleton areas, that have very high rates of ACP completion. Multiple papers have reported that community involvement and community classes are the best way to educate patients and promote ACP, and this may explain the differences in geographical completion rate as well as highlight the differences in resources available to certain demographics.

Interviews with different health systems noted the importance of staff education as well as patient education to increase utilization. There was higher compliance where a standardized process and workflow was in place. There is preliminary data to suggest there are financial incentives for health systems to develop robust ACP protocols as proper ACP documentation can reduce guardianships and prolonged hospital stays.

The next step in the project will be evaluating the current population of patients with ACP documents to better assess the true number of patients that have a legally recognized Advance Care Planning document.

“This research has meant a great deal to me. Working with Dr. Lange and all of the other wonderful people has truly been an honor,” stated Breanna. “This research has really given me the opportunity to actually make a difference. To advocate for patients, to make things better, to improve the quality of end of life – to make it patient centered.” She adds, “Before medical school, as a certified nursing assistant I felt I was disposable. My ideas, thoughts and opinions didn’t matter. I wasn’t able to advocate for any of the patient suffering I witnessed. I am incredibly grateful to the Foundation for allowing me to start this career-long journey in promoting patient autonomy and end of life through advance care documentation.” 

The Wisconsin Medical Society Foundation is proud to offer fellowship opportunities to medical students. Fellowships offer Wisconsin medical students the opportunity to work under the guidance of a Wisconsin physician on a health education or research project to advance the health of the people of Wisconsin, providing Wisconsin medical students hands-on experiences working in Wisconsin communities or with specific patient populations to address a health concern, integrating their knowledge of resources available. Supporting fellowships such as Breanna’s not only benefits the students, but Wisconsin patients and their families.

Please consider supporting important medical research of Wisconsin physicians and students through the Wisconsin Medical Society Foundation Fellowship Fund. For more information about this, or any Foundation program, please contact Jaime Craig.

We would also love to see you at Health & Harmony, our annual event on April 14 at Monona Terrace, as we raise funds for the many important programs of the Wisconsin Medical Society Foundation.

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Justice, equity, diversity and inclusion in health care focus of Health & Harmony, annual event, CME

Health & Harmony, the Wisconsin Medical Society’s medical education, Foundation fundraiser and annual business meeting, will be held April 14 and 15 at the Monona Terrace in Madison. The education conference will focus on justice, equity, diversity and inclusion in health care and the Foundation event will celebrate outstanding health professionals. There will be food, drinks, a wine pull and raffle baskets while guests wait for the program and dueling pianos to start. 

We hope you can join us! Purchase an education conference ticket for just $149 and get one Foundation event ticket for free. Additionally, WisMed members get discounted CME registration! Contact education@wismed.org to get your coupon code. Register here for part or all of the Annual Event.

The education conference has been approved for AMA PRA Category 1 Credit™ and will help learners define social determinants of health inequity and identify strategies to apply Justice, Equity, Diversity and Inclusion into clinical practice encounters and medical decision-making.

Jesse Ehrenfeld, MD, MPH, American Medical Association President-elect, senior associate dean, tenured professor of anesthesiology and director of the “Advancing a Healthier Wisconsin Endowment” at the Medical College of Wisconsin, will present Physician Leadership in Advancing Equity in Health Innovation.

Additionally, the Foundation’s 2023 Superhero of Medicine honoree, Karen Watson, MD, FACOG, OB-GYN at Ascension SE Wisconsin Hospital - St. Joseph’s Campus, will be participating on a panel about Maternal and Infant Health Inequity.

Plan your weekend for Health & Harmony, the WisMed Annual Event:

• Medical Education Conference - April 14, 9 a.m.
• Foundation Fundraising Event - April 14, 5 p.m.
• Annual Business Meeting - April 15, 9 a.m. 

Register here for part or all of the weekend.

Additionally, we are excited to announce sponsorship and exhibitor opportunities for Health & Harmony! Exhibitors will spend the day connecting with Health & Harmony attendees from across the state. In addition to the booth, you will have the opportunity to have a table at our evening event allowing for the connection (and fun!) to continue.

Learn more here or contact Mikaela Powers.

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Get to know the WisMed Assure team – Mary Krueger

WisMed Assure, the Wisconsin Medical Society’s insurance agency, offers members discounts on and exclusive access to insurance products including medical malpractice insurance, business owners’ insurance, WPS Medicare Supplement program, dental, health, disability and life insurance. WisMed Assure’s Team Income Defense helps individual physicians protect their income.

The team consists of Tom Strangstalien, Insurance Advisor, Lisa Koerner, Insurance Advisor, and Mary Krueger, Insurance Advisor.

Today we’ll learn more about Mary Krueger.

What products and services does Team Income Defense provide?

We provide comprehensive disability coverages, simple to complex life insurance, annuities and estate planning coordination.

Why is it important for physicians to have this coverage in place?

Physicians have a unique profession that exposes them to risks every day – both on and off the job. These programs allow our members and their families to continue to live the lifestyle they are accustomed to if the member should suffer from a serious illness, injury or loss of life. When it comes to health insurance, we can help make sure our clients have needed coverage as they move towards retirement - whether it’s a Medicare Supplement, Advantage Plan or Part D for your prescriptions.

Tell us a little about your background and why you do what you do?

I love people and enjoy researching what will make people’s lives easier. I have been passionate about providing that assistance for more than 40 years. The joy of seeing plans work over their lifetime brings me great satisfaction and further emphasizes paying it forward.

What’s different about WisMed Assure?

WisMed Assure believes in teamwork for the client. We research and confer with others, when necessary, to find suitable coverages and will locate representatives in other states or companies we don’t represent to give our members the best benefits possible. WisMed Assure works with several companies with programs designed specifically for the needs of the medical community while treating you like a member of their family.   

WisMed Assure is a service of the Wisconsin Medical Society. Our revenue supports the fulfillment of the Society’s mission to improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.    

What’s your favorite client story?

My very favorite story is about client in her 70s whose husband was in a long-term care facility with Alzheimer’s. She was left to handle all their assets alone because she didn’t want their children to have to deal with it. When we met, she was very apprehensive about sharing their information. We rewrote her plans several times as she became more comfortable working together. She had so many questions and it was enjoyable to learn about her family and wishes. As of today, she is like a mom to me, her children are so relieved, her grandchildren and great grandchildren look at me as family…someone who is always looking out for them as a financial partner for life.

Reach out to the WisMed Assure team at insurance@wismedassure.org, complete this quick online form or call 608.442.3810 for help with your insurance needs.

WisMed Assure is the Wisconsin Medical Society’s insurance agency – profits earned support the mission of the Medical Society.

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Digital marketing discount for WisMed members

Wisconsin Medical Society members can access an exclusive discount to produce a digital marketing or TV broadcast campaign with WMSN Fox 47 News. Digital marketing (commercials on streaming services) is a fraction of the cost of traditional TV commercials.

Additionally, this discount includes creative design and bilingual services. There are no production fees on the commercial, the ads can be targeted to key market segments and the campaign results can be tracked.

Learn more about this great opportunity or contact Chris Lezotte at clezotte@sbgtv.com or 608.662.5019.

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Use clear medication directions for patients to improve patient engagement

Approximately 25-50% of patients do not take their medication correctly or forget to take their medication, which results in toxicity or inadequate control of chronic conditions. Certain demographics, such as patients who take multiple medications a day, are more than 65 years old or have poor literacy are more likely to have difficulty managing their medication.

Prescribers can help all patients take their medication correctly and consistently by using Universal Medication Schedule directions that use health literacy best practices such as clear ‘morning,’ ‘noon,’ ‘evening’ and ‘bedtime’ frequencies. Wisconsin Health Literacy, a non-profit organization based in Madison, Wisconsin, has created a Universal Medication Schedule Toolkit for health systems that would like to adopt this practice to improve medication communication and patient engagement.

Please contact Jim Lorence for additional information. 

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Your expertise is needed to understand the care of patients with behavioral and psychological symptoms of dementia in primary care

Art Walaszek, MD, the Wisconsin Alzheimer’s Institute (WAI) and colleagues at University of Wisconsin-Madison are studying educational approaches to the management of behavioral and psychological symptoms of dementia (BPSD) in primary care.

They are asking you to complete a brief, one-time survey to help them understand how primary care clinicians approach the care of persons with BPSD. The survey will take approximately 5-10 minutes to complete. You are eligible to complete the survey if you are a primary care clinician who provides care to patients age 65 years and older.

This research study is completely voluntary. You may skip any survey questions that you do not want to answer. Once you start the survey, you can stop at any time. All your answers are confidential and will not be shared with anyone outside the research team. You will have the option to include your name and contact information if you would like to be contacted for follow-up or future participation.

Please contact Molly Schroeder at mjschroeder3@wisc.edu or 608.262.6910 with questions about this research study.

To participate, please click this link to fill out the survey by Friday, March 10. Thank you for taking the time to share your expertise. The Wisconsin Medical Society has signed a letter of support for this project. 

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Free program for health care students and professionals to cope with life stress

Health care professionals, medical students, public health staff, educators and caregivers can join WeCOPE, a free evidence-based program that explores emotional awareness, gratitude, mindfulness, self-compassion and more. Presented by University of Wisconsin Extension and Northern Highland, WeCOPE has been shown to reduce stress and depression.

Participants will meet virtually on Tuesdays from noon to 1:00 p.m. for six weeks, starting March 21. Participants will learn and practice skills such as mindfulness, positive reappraisal, gratitude and goal setting through small group discussion, self-reflection and activities. Click here to register.

Please contact jennifer.parkmroch@wisc.edu with questions or learn more here.

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