scholarly journals Feasibility of a Video-Based Advance Care Planning Website to Facilitate Group Visits among Diverse Adults from a Safety-Net Health System

2018 ◽  
Vol 21 (6) ◽  
pp. 853-856 ◽  
Author(s):  
Carly Zapata ◽  
Hillary D. Lum ◽  
Emily Wistar ◽  
Claire Horton ◽  
Rebecca L. Sudore
Keyword(s):  
Health System ◽  
Advance Care Planning ◽  
Safety Net ◽  
Care Planning ◽  
Group Visits ◽  
Advance Care

scholarly journals Primary care provider‐led group visits for advance care planning in the safety net

2021 ◽  
Author(s):  
Heather B. Schickedanz ◽  
Rhonda Polzin ◽  
Stefanie D. Vassar ◽  
Arleen F. Brown ◽  
Karen J. Kim
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Care Provider ◽  
Primary Care Provider ◽  
Safety Net ◽  
Care Planning ◽  
Group Visits ◽  
Advance Care

scholarly journals Population-Based Pragmatic Trial of Advance Care Planning in Primary Care in the University of California Health System

2019 ◽  
Vol 22 (S1) ◽  
pp. S-72-S-81 ◽  
Author(s):  
Anne M. Walling ◽  
Rebecca L. Sudore ◽  
Doug Bell ◽  
Chi-Hong Tseng ◽  
Christine Ritchie ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Advance Care Planning ◽  
Pragmatic Trial ◽  
Population Based ◽  
University Of California ◽  
Care Planning ◽  
Advance Care ◽  
The University

Health disparities in advance care planning at a safety-net hospital.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 125-125 ◽  
Author(s):  
Elizabeth Levin ◽  
Michael Ries ◽  
Jeffrey B Rubins ◽  
Andres Wiernik
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Advance Care Planning ◽  
Safety Net ◽  
Stage Iii ◽  
English Speakers ◽  
Care Planning ◽  
Advance Care ◽  
English Speaking

125 Background: Advance health care directives (AHCDs) are recommended by ASCO as a strategy to improve compliance with patient wishes at the end-of-life, thereby facilitating appropriate use of health care resources. We already know too few cancer patients complete AHCDs, but we know less about barriers to their completion. This study assessed the frequency with which AHCDs were completed in different ethnic groups and whether hospice enrollment varied by ethnicity. Methods: Retrospective analysis conducted at Hennepin County Medical Center in Minneapolis, MN with review of the cancer registry data from 2008 to 2013. Data were collected for deceased patients with stage III-IV cancer from the time of diagnosis through death. Demographics, AHCD, hospital deaths, enrollment in hospice, and individual patient data were analyzed using logistic regression, adjusting for both race and language as covariates. Results: From 2008 to 2013, there were 273 patients diagnosed with stage III-IV cancer and followed through death. Fourteen percent of patients were non-English speaking. Thirty-one percent were African American (AA), 4% were Hispanic, and 4% were Asian. Only 21% of patients completed an AHCD during their care, and none were Asian or Hispanic. English speakers were almost five times more likely than non-English speakers to have an AHCD (OR = 4.66, 95% CI = (1.06, 20.46), p = 0.04). Fifty-one percent of English-speaking patients enrolled in hospice compared to 39% of non-English-speaking patients (p = 0.08). Sixty percent of patients with an AHCD enrolled in hospice compared to 46% of those patients without an AHCD (p = 0.10). Forty-three percent of patients with an AHCD died in the hospital, 33% of whom died in an intensive care unit (ICU), versus 46% without an AHCD, 49% of whom died in an ICU. Of patients with advanced cancer, 46% died in the hospital and 21% died in the intensive care unit (ICU). Conclusions: Non-English-speaking patients are far less likely to have an AHCD than English speakers. Some ethnicities in our study had no patients with an AHCD. Since completing an AHCD may increase hospice enrollment and decrease ICU deaths, strategies to promote advance care planning are urgently needed, particularly with non-English speaking patients.

Synchronizing advance directives among patients across a health system.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 233-233
Author(s):  
Sherri Rauenzahn Cervantez ◽  
Sadiyah Hotakey ◽  
Amanda Hernandez ◽  
Stephanie Warren ◽  
Jennifer Quintero ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health System ◽  
Advance Care Planning ◽  
Primary Care Clinic ◽  
Care Planning ◽  
Care Clinic ◽  
Care Plans ◽  
Palliative Oncology ◽  
Advance Care

233 Background: Advance directives (ADs) are legal tools that direct treatment or decision making and appoint a surrogate decision-maker (health care proxy). The presence of ADs is associated with decreased rates of hospitalization, use of life-sustaining treatment, and deaths in a hospital setting. Additionally, completed ADs lead to increased use of hospice or palliative care, more positive family outcomes, improved quality of life for patients, and reduced costs for healthcare. Despite the benefits of advance care planning, only 18-36% of adults have completed advance care plans. The aims of our pilot study were to 1) implement a synchronized system for advance care planning across the UT Health San Antonio health system and 2) improve advance care planning rates in a primary care clinic and palliative oncology clinic. Methods: During a 10-month prospective period, system processes for advance care planning were reviewed with identification of three primary drivers for advance care plan completion: a) electronic/EMR processes, b) clinical workflows and training, and c) patient resources and education. As a result of this quality improvement initiative, standardized forms, resources, and processes for obtaining advance care plans were implemented in the selected clinics. Results: At baseline, the primary care clinic had 84/644 (13%) patients and the palliative oncology clinic had 25/336(7%) with completed advance care plans. With the implementation of a standardized process, 108 patients (23% increase in rate of completion) in the primary clinic and 56 patients (71% increase in rate of completion) in the palliative oncology setting completed advance care planning (ACP). Additionally, there was a 5-fold increase in billing of ACP CPT codes within the clinics during the first 6 months compared to the prior full year. Conclusions: While this quality improvement pilot initiative was limited to two clinics, the synchronized modifications suggest that the system changes could be expanded to other clinics in our UT health system to promote ACP discussions, completion of plans, and ultimately improved patient care.

scholarly journals Evaluation of the national implementation of the VA Diffusion of Excellence Initiative on Advance Care Planning via Group Visits: Protocol for a quality improvement evaluation

2020 ◽  
Author(s):  
Monica M. Matthieu ◽  
Songthip T. Ounpraseuth ◽  
Jacob Painter ◽  
Angie Waliski ◽  
James “Silas” Williams ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Advance Care Planning ◽  
Implementation Strategies ◽  
Care Planning ◽  
National Program ◽  
Group Setting ◽  
Group Visits ◽  
National Implementation ◽  
Advance Care ◽  
The Impact

Abstract Background Traditionally system leaders, service line managers, researchers, and program evaluators, hire specifically dedicated implementation staff to ensure that a healthcare quality improvement effort can “go to scale”. However, little is known about the impact of hiring dedicated staff and whether funded positions, amid a host of other delivered implementation strategies, is the main difference among sites with and without funding used to execute the program, on implementation effectiveness and cost outcomes. Methods/Design In this mixed methods program evaluation, we will determine the impact of funding staff positions to implement, sustain, and spread a program, Advance Care Planning (ACP) via Group Visits (ACP-GV), nationally across the entire United States Department of Veterans Affairs (VA) healthcare system. In ACP-GV, Veterans, their families, and trained clinical staff with expertise in ACP meet in a group setting to engage in discussions about ACP and the benefits to Veterans and their trusted others of having an Advance Directive (AD) in place. To determine the impact of the ACP-GV National Program, we will use a propensity score matched control design to compare ACP-GV and non-ACP-GV sites on the proportion of ACP discussions in VHA facilities. To account for variation in funding status, we will document and compare funded and unfunded sites on the effectiveness of implementation strategies (individual and combinations) used by sites in the National Program on ACP discussion and AD completion rates across the VHA. In order to determine the fiscal impact of the National Program and to help inform future dissemination across VHA, we will use a budget impact analysis. Finally, we will purposively select, recruit, and interview key stakeholders, who are clinicians and clinical managers in the VHA who offer ACP discussions to Veterans, to identify the characteristics of high-performing (e.g., high rates or sustainers) and innovative sites (e.g., unique local program design or implementation of ACP) to inform sustainability and further spread. Discussion As an observational evaluation, this protocol will contribute to our understanding of implementation science and practice by examining the natural variation in implementation and spread of ACP-GV with or without funded staff positions.

Impact of group visits for older patients with heart failure on advance care planning outcomes: Preliminary data

2021 ◽  
Author(s):  
Sangeeta C. Ahluwalia ◽  
Julia I. Bandini ◽  
Alexis Coulourides Kogan ◽  
David B. Bekelman ◽  
Bonnie Olsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Advance Care Planning ◽  
Preliminary Data ◽  
Older Patients ◽  
Care Planning ◽  
Group Visits ◽  
Patients With Heart Failure ◽  
Advance Care
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