Enhancing Advance Care Planning in a Geriatric Clinic
Journal Title: Palliative Medicine & Hospice Care – Open Journal - Year 2018, Vol 4, Issue 1
Abstract
Context: Academic primary care geriatric clinic. Objective: We sought to increase advance care planning (ACP) discussions at an academic primary care geriatric clinic utilizing the electronic medical record (EMR). The measure was the number of documented ACP discussions. Methods: Two plan-do-study-act (PDSA) quality improvement cycles. Phase 1: engagement of physicians and development of a patient information sheet with advanced directive forms for inclusion in the patient take-home clinic summary. Phase 2: engagement of clinic staff to screen for patient readiness for ACP discussions and to remind physicians. Results: At baseline, 47.7% of patients had advanced directive documents in their EMR, and there was an 11.1% advance directive document completion following ACP discussions. Over a 3 month intervention, the rate of alternative dispute resolution (ADR) discussions remain unchanged at 3.4% of patients during Phase 1 but increased to 7.63% (94.6% increase) during Phase 2. Conclusions: A team-based approach targeting patients prepared for ACP discussions was able to double incident new ACP discussions. Physicians identified several barriers to ACP discussions including patient readiness, time constraints, EMR constraints, and regulatory factors.
Authors and Affiliations
James S. Powers
Keywords
Related Articles
- EP ID EP549344
- DOI 10.17140/PMHCOJ-4-126
- Views 144
- Downloads 0
Qualitative Study for the Development of a Telemedicine System in Palliative Care
Introduction: Technological advances in public health have allowed the life expectancy of people to increase. However, new challenges appear in populations that age as the greatest number of chronic and oncological disea...
Delivering Palliative Care Education where there is Little Concept of Palliative Care: The Cultural Challenges
Volunteering to teach abroad in a country where palliative care is not well-established, either as a concept or service, is professionally stimulating and challenging. It provides an opportunity to learn about other soci...
Implementation of Palliative Care in Palestine: Cultural and Religious Perspectives
The care of terminally ill cancer patients poses a significant global public health problem.1 Populations are growing older as healthcare interventions become increasingly more effective in the management of chronic dise...
Cultural Challenges in Implementing Palliative Services in Lebanon
Palliative Care (PC) is a relatively new discipline in Lebanon with some progress being made in recent years. Based on our clinical experience, we describe and discuss the cultural aspects of palliative care, the attitud...
The Challenge of Allocating Scarce Medical Resources During a Disaster in a Low Income Country: A Case Study from the 2010 Haitian Earthquake
Scarce medical resources during a natural disaster challenge the existing protocols for medical intervention. Triage decisions about which patient to care for can be extremely stressful for a medical team. This case anal...