The Impact of a Community-Based Serious Illness Care Program on Healthcare Utilization and Patient Care Experience

2019 ◽  
Vol 67 (4) ◽  
pp. 825-830 ◽  
Author(s):  
Timothy P. Daaleman ◽  
Natalie C. Ernecoff ◽  
Christine E. Kistler ◽  
Alfred Reid ◽  
David Reed ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare Utilization ◽  
Care Program ◽  
Community Based ◽  
Serious Illness ◽  
Care Experience ◽  
The Impact

The serious illness care program.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 12-12 ◽  
Author(s):  
Rachelle Bernacki ◽  
Susan Block
Keyword(s):  
End Of Life ◽  
Controlled Trial ◽  
Clinical Care ◽  
Care Program ◽  
Depression Score ◽  
Serious Illness ◽  
Clinician Training ◽  
The Mean ◽  
Surprise Question ◽  
The Impact

12 Background: Conversations between patients and clinicians about end-of-life care allow patients to prepare and plan for the end of life and are associated with improved outcomes. Objective: To determine the impact of a structured, seven-item conversation guide on anxiety and depression in patients with an estimated prognosis under a year. Methods: A cluster, randomized controlled trial enrolled 81 clinicians and 272 patients (goal of 400 patients) at Dana Farber Cancer Institute. The intervention (integrated into regular clinical care by oncologists) consisted of a system to identify patients and trigger clinician discussions using the checklist, clinician training, and documentation template in the electronic medical record. Adult patients were identified by oncologists using the “surprise” question. Surveys measured key outcomes before and after administration of the checklist (for patients) and after training (for oncologists). Results: 1,299 patients were identified using the surprise question. Of patients contacted, 332 agreed to participate and 254 declined. To date, 62 conversations are complete with a median length of 20 minutes (range: 8-70 min). The mean anxiety level using the GAD-7 score for the participants with complete data prior to the checklist conversation was 4.0 and post-conversation 3.1 (p=0.04). The mean depression score using the PHQ-9 prior to the checklist conversation was 6.3 and post-conversation 5.7 (p=0.2). 51% of patients found the discussion ‘very’ or ‘extremely’ helpful; 21% found the discussion ‘somewhat’ helpful; and 14% ‘slightly’ or ‘not at all’ helpful. The majority of clinicians found the guide simple (79%) and easy to use (78%); 81% reported they would continue its use after the trial. Conclusions: These preliminary data demonstrate that use of the guide is feasible, acceptable to patients and clinicians, and does not lead to increased anxiety or depression. There is a trend towards a significant reduction in anxiety in patients who had the discussion with their oncologists. The Serious Illness Care Program is an acceptable intervention to support clinicians in conducting conversations about end-of-life values and goals with patients, allowing them to articulate their wishes about future medical care. Clinical trial information: NCT01786811.

Palliative Care in a Community-Based Serious-Illness Care Program

2020 ◽  
Vol 23 (5) ◽  
pp. 692-697 ◽  
Author(s):  
Natalie C. Ernecoff ◽  
Laura C. Hanson ◽  
Alexandra L. Fox ◽  
Timothy P. Daaleman ◽  
Christine E. Kistler
Keyword(s):  
Palliative Care ◽  
Care Program ◽  
Community Based ◽  
Serious Illness

scholarly journals Developing An Analytic Approach to Understanding the Patient Care Experience

2016 ◽  
Vol 3 (4) ◽  
pp. 151-154 ◽  
Author(s):  
Mary Kate Springman ◽  
Yalissa Bermeo ◽  
Heather M Limper ◽  
Alison S Tothy
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Patient Care ◽  
Patient Experience ◽  
Medical Center ◽  
Analytic Approach ◽  
Care Experience ◽  
Patient Voice ◽  
Reporting Tool ◽  
The Impact

The amount of data available to health-care institutions regarding the patient care experience has grown tremendously. Purposeful approaches to condensing, interpreting, and disseminating these data are becoming necessary to further understand how clinical and operational constructs relate to patient satisfaction with their care, identify areas for improvement, and accurately measure the impact of initiatives designed to improve the patient experience. We set out to develop an analytic reporting tool deeply rooted in the patient voice that would compile patient experience data obtained throughout the medical center.

scholarly journals Evaluating the care provision of a community-based serious-illness care program via chart measures

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Christine E. Kistler ◽  
Matthew J. Van Dongen ◽  
Natalie C. Ernecoff ◽  
Timothy P. Daaleman ◽  
Laura C. Hanson
Keyword(s):  
Quality Of Care ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Care Program ◽  
Academic Community ◽  
Care Provision ◽  
Community Based ◽  
Serious Illness ◽  
Home Based

Abstract Background Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model. Methods Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n = 159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access. Results Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35, 22, 21%, respectively). Conclusion This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.

Enhancing Medical Learners’ Knowledge of, Comfort and Confidence in Holding Serious Illness Conversations

2019 ◽  
Vol 36 (12) ◽  
pp. 1096-1104 ◽  
Author(s):  
Vivian Tam ◽  
John J. You ◽  
Rachelle Bernacki
Keyword(s):  
Medical Students ◽  
Qualitative Content Analysis ◽  
Care Program ◽  
First Year ◽  
Post Intervention ◽  
Serious Illness ◽  
Peace Of Mind ◽  
Clinician Training ◽  
Seriously Ill Patients ◽  
The Impact

Objectives: Having early discussions with seriously ill patients about their priorities and values can improve their peace of mind and family outcomes during bereavement; however, physicians and medical students report feeling underprepared to hold serious illness conversations. We evaluated the impact of the Serious Illness Care Program clinician training workshop on medical learners’ knowledge of comfort and confidence in holding such conversations. Methods: Eligible learners were penultimate- or final-year medical students or first-year residents of generalist programs (Family Medicine, Internal Medicine). Learners participated in a 2.5-hour workshop involving reflection on serious illness discussions, didactic teaching and demonstration of the Serious Illness Conversation Guide (SICG), role play with standardized patients, direct observation, and feedback from experts. Participants completed pre- and post-intervention questionnaires with Likert-type scale and open-ended questions, which were analyzed using paired t tests and qualitative content analysis, respectively. Results: We enrolled 25 learners. The intervention was associated with an increase in knowledge ( P < .001) and self-efficacy ( P < .001). All learners reported gaining new skills, with a majority specifically identifying a framework for structuring serious illness conversations in the qualitative analysis (n = 14, 56%). Participants stated the workshops would improve their comfort in holding serious illness conversations (n = 24, 96%), and that it would be valuable to integrate the workshops into their formal curricula (n = 23, 92%). Conclusions: Training on the use of the SICG is novel for medical students and first-year residents and associated with the improvement in their knowledge of and perceived capacity to hold serious illness conversations. This study suggests that the integration of SICG training into medical curricula may have educational value.

scholarly journals The impact of Ethiopia's pilot community based health insurance scheme on healthcare utilization and cost of care

2019 ◽  
Vol 220 ◽  
pp. 112-119 ◽  
Author(s):  
Anagaw D. Mebratie ◽  
Robert Sparrow ◽  
Zelalem Yilma ◽  
Degnet Abebaw ◽  
Getnet Alemu ◽  
...  
Keyword(s):  
Health Insurance ◽  
Healthcare Utilization ◽  
Cost Of Care ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Community Based ◽  
Community Based Health Insurance ◽  
The Impact

scholarly journals Paramedics and serious illness: communication training

2019 ◽  
pp. bmjspcare-2018-001734
Author(s):  
Nikki Jane Pease ◽  
Jenifer Jeba Sundararaj ◽  
Edward O'Brian ◽  
Joanne Hayes ◽  
Edward Presswood ◽  
...  
Keyword(s):  
Patient Care ◽  
End Of Life ◽  
Symptom Control ◽  
Death And Dying ◽  
Real Life ◽  
Ambulance Service ◽  
Serious Illness ◽  
Use Of Resources ◽  
Service Staff ◽  
The Impact

ObjectivesThe need to empower Ambulance Service staff at the point of delivery of end of life care (EoLC) is crucial. We describe the delivery, outcomes and potential impact of the Serious Illness Conversation project delivered to Welsh Ambulance Service Trust (WAST) staff. Over an 18-month period, 368 WAST staff attended face-to-face teaching, which included serious illness conversation communication skills, symptom control and ‘shared decision making’.MethodData collected from WAST staff were used to gain insight on perception of their role and challenges within the context of EoLC, understand the impact of teaching on self-confidence and identify impact on the wider service. A mixed methods approach was used for data analysis.ResultsWAST staff view themselves in several important roles, acting as ‘facilitators’ to patient-centred, seamless care, providing support, liaison between services and practical help in patient care at the end of life. The difficult questions and situations pertaining to EoLC were related to discussions on death and dying and managing expectation. The predominant barriers identified related to communication. Quantitative outcomes on the six communication domains indicate statistically significant improvement in self-assessed confidence. The overall impact to the wider ambulance service suggests a trend towards better use of resources.ConclusionThe perceived roles and challenges identified by paramedics can help in customising training objectives. The initial outcomes from the ongoing project with WAST demonstrate increased confidence in handling communication issues. Initial successive surveys suggest teaching is making a real life impact on patient care at end of life.

scholarly journals Avoided Hospitalization Criteria: Validating the Impact of a Community-Based Palliative Care Program

2020 ◽  
Vol 1 (1) ◽  
pp. 246-250
Author(s):  
Gobi Paramanandam ◽  
Barbara E. Volk-Craft ◽  
Rachel Mayer Brueckner ◽  
Theresa M. O'Sullivan ◽  
Erin Waters
Keyword(s):  
Palliative Care ◽  
Care Program ◽  
Palliative Care Program ◽  
Community Based ◽  
The Impact

scholarly journals Evaluating the Care Provision of a Community-Based Serious-Illness Care Program Via Chart Measures

2020 ◽  
Author(s):  
Christine Kistler ◽  
Matthew Van Dongen ◽  
Natalie Ernecoff ◽  
Timothy Daaleman ◽  
Laura Hanson
Keyword(s):  
Quality Of Care ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Care Program ◽  
Academic Community ◽  
Care Provision ◽  
Community Based ◽  
Serious Illness ◽  
Home Based

Abstract Background: Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model.Methods: Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n=159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access.Results: Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35%, 22%, 21%, respectively). Conclusion: This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.

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