Prevalence of advance care planning in a resident run clinic in an underserved community.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24067-e24067
Author(s):  
Swetha Ann Alexander ◽  
Vinay Mathew Thomas ◽  
David Wu ◽  
Radhika Kulkarni ◽  
William Rabitaille
Keyword(s):  
Primary Care ◽  
African American ◽  
Advance Care Planning ◽  
Primary Care Clinic ◽  
Retrospective Chart Review ◽  
Care Planning ◽  
Care Clinic ◽  
Underserved Community ◽  
Advance Care ◽  
End Stage

e24067 Background: Advance Care Planning (ACP) ensures that patients receive care that is in line with their values and preferences. ACP is best done in the outpatient setting. Despite recognizing the importance of ACP, the rates of ACP completion continue to be low. We conducted a retrospective study to determine the rates of ACP in a resident run primary care clinic in Hartford, Connecticut, which serves the underserved community. We looked at patient characteristics to find correlation with ACP completion. We also aimed to determine the reasons which could decrease the completion of ACP. Methods: This was a retrospective chart review. Patients who met any of the inclusion criteria [i) Age>65 ii) End stage renal disease on dialysis iii) Metastatic/Recurrent cancer iv) End stage heart failure v) COPD Gold stage D] and were seen in the primary care clinic from September 1, 2019 to December 31, 2019 were selected. Their charts were reviewed to see if ACP was documented during primary care visits over the past two years. The demographics of the patients were noted. Subsequently, a survey was distributed to residents to determine the possible causes of low rates of ACP discussion. Results: The characteristics of the 373 patients included in the study are shown in Table 1. Only 14 (3.8%) of the 373 had documentation of ACP during their primary care visits. The characteristics of the 14 patients in whom ACP was done are as follows: Sex- Female 9/14 (64%); Ethnicity- Hispanic 10/14 (71%), African American 4/14 (29%); Religious Affiliation- Christian 13/14 (93%), None 1/14 (7%); Married/Partner 2/14 (14%). Patient demographics including sex (p 0.6), religious beliefs (p 0.8), and marital status (p 0.6) did not show any correlation with the likelihood of ACP completion. Of the 31 residents who answered the survey, the most commonly listed barriers to ACP completion were the following: lack of time to conduct these discussions (94%), forgetting to conduct ACP discussions (48%), and lack of training (19%). All the residents believed that ACP discussion was beneficial to patients and medical providers. Conclusions: The rates of ACP planning in our clinic are much lower than the national average. African American and Hispanics, who make up the majority of our clinic population, traditionally have had low rates of ACP completion. This is an important issue that needs to be addressed. Advance care planning training should be also be strengthened during residency. [Table: see text]

scholarly journals Advance Care Planning in a Geriatric Primary Care Clinic: A Retrospective Chart Review

2018 ◽  
Vol 36 (1) ◽  
pp. 24-27 ◽  
Author(s):  
Ariana Barkley ◽  
Mike Liquori ◽  
Amy Cunningham ◽  
John Liantonio ◽  
Brooke Worster ◽  
...  
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Chart Review ◽  
Demographic Variable ◽  
Primary Care Clinic ◽  
Retrospective Chart Review ◽  
Care Planning ◽  
Power Of Attorney ◽  
Care Clinic ◽  
Advance Care

Purpose: Advance care planning (ACP) is theorized to benefit both the patient and their family when end of life is near as well as earlier in the course of serious illness. However, ACP remains underutilized, and little is known about the nature of ACP documentation in geriatrics practices. The study investigated the prevalence and nature of ACP documentation within a geriatric primary care clinic. Methods: A retrospective chart review was conducted on a randomly selected sample of electronic medical record (EMR) charts. The sample consisted of patients aged 65 and older who were seen in the clinic from January 1, 2015, to December 31, 2016. Charts were reviewed for ACP documentation and data regarding age, gender, race, religion, comorbidities (end-stage renal disease, congestive heart failure, cancer, and dementia), recent hospitalizations, and visit type. Results: Ninety-eight charts were reviewed (n = 98). Nine patients (9.18%) had an advance directive (AD) or power of attorney (POA) available within their EMR. Twenty-five patients (25.5%) had provider notes documenting that they have an AD, POA, or preferred health-care decision maker; however, no documents were available. The remaining 64 (65.3%) patients had no evidence of ACP documentation within their EMR. Age was the only demographic variable associated with completion of an AD ( P = .038). Discussion: The rate of ACP documentation (34.6%) was lower than the average among US adults aged 65 and over (45.6%); further, most patients with ACP documentation did not have an AD or POA on file. The authors plan to reevaluate ACP statistics in the same office following a future intervention.

Improving Advance Care Planning in a Resident Primary Care Clinic

2019 ◽  
Vol 37 (3) ◽  
pp. 185-190
Author(s):  
Nicholas J. Nassikas ◽  
Grayson L. Baird ◽  
Christine M. Duffy
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Advance Care Planning ◽  
Primary Care Clinic ◽  
Internal Medicine Resident ◽  
Chronically Ill ◽  
Care Planning ◽  
Care Clinic ◽  
Medicine Resident ◽  
Advance Care

Introduction: Two-thirds of chronically ill patients do not have an advance directive. The primary aim of this study was to develop an intervention to increase the documentation of advance directives in elderly adults in an internal medicine resident primary care clinic. The secondary aims were to improve resident confidence in discussing advance care planning and increase the number of discussions. Methods: The study was a pre- and postintervention study. The study intervention was a 30-minute educational session on advance care planning. Study participants were patients aged 65 years and older who were seen in an internal medicine residency primary care clinic over a 6-month period and internal medicine residents. Clinic encounters were reviewed for the presence of advance care planning discussions before and after the intervention. Resident confidence was measured on a Likert scale. Results: Two hundred ninety-five eligible patients were seen in the clinic from January 1, 2017, to June 30, 2017, and included in the analysis performed between 2017 and 2018. The mean number of documented advance care planning discussions increased from 2.24 (95% confidence interval [CI]: 1.0-4.9) during the preintervention period to 8.94 (95% CI: 5.94-13.24]) during the postintervention period ( P = .0011). Following the intervention, residents overall reported increased confidence in discussing advance care planning. Conclusion: A relatively modest intervention to increase advance care planning discussions is feasible in an internal medicine primary care clinic and can improve the confidence of residents with end-of-life discussion.

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 Validation of the psychometric properties of the Malay advance care planning questionnaire

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mun Kit Lim ◽  
Pauline Siew Mei Lai ◽  
Pei Se Wong ◽  
Sajaratulnisah Othman ◽  
Fadzilah Hanum Mohd Mydin
Keyword(s):  
Factor Analysis ◽  
Psychometric Properties ◽  
Advance Care Planning ◽  
Response Rate ◽  
Factor Model ◽  
Tertiary Education ◽  
Primary Care Clinic ◽  
Care Planning ◽  
Care Clinic ◽  
Advance Care

Abstract Background There is a growing interest among the developing countries on advance care planning (ACP) due to the reported benefits of planning ahead in the developed countries. Validated instruments in various languages have been developed to facilitate study on the views of public prior to its implementation. However, instrument to explore the views on ACP in Malay has not been developed and validated yet, even though Malay is spoken extensively by approximately 220 million people in the Malay Archipelago. There is also a need for instrument in Malay language to facilitate the assessment of knowledge, attitude and practice (KAP) of Malaysians regarding ACP. Therefore, the aim of this study was to validate the psychometric properties of the Malay Advance Care Planning Questionnaire (ACPQ-M). Methods The ACPQ was translated according to international guidelines. This validation study was conducted from January to June 2018. Participants who were ≥ 21 years old, and able to understand Malay were recruited from an urban primary care clinic and a tertiary education institution in Malaysia. A researcher administered the ACPQ-M to participants via a face-to-face interview at baseline and 2 weeks later. Each interview took approximately 10–20 min. Results A total of 222/232 participants agreed to participate (response rate = 96.0%). Exploratory factor analysis and confirmatory factor analysis found that the ACPQ-M was a 4-factor model. The Cronbach’s α values for the four domains ranged from 0.674–0.947. Only 157/222 participants completed the test-retest (response rate = 71%). At test-retest, quadratic weighted kappa values for all domains ranged from 0.340–0.674, except for two domains which ranged from − 0.200-0.467. Conclusions The ACPQ-M was found to be a 4-factor model, and a valid and reliable instrument to assess the KAP regarding ACP. This instrument can contribute to profound understanding of the KAP of Malaysians regarding ACP, and assist policy makers in determining the readiness for legislation of ACP in Malaysia.

scholarly journals 49 Introducing A Geriatrician Into A Renal Service to Aid Decision-Making and Advance Care Planning

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i14-i17
Author(s):  
V Aylett ◽  
A Mooney ◽  
Z Kime ◽  
A Windass
Keyword(s):  
Advance Care Planning ◽  
Conservative Management ◽  
Older Patients ◽  
Care Plan ◽  
Care Planning ◽  
Care Clinic ◽  
Advance Care ◽  
Stage Renal Disease ◽  
End Stage ◽  
Aid Decision

Abstract Introduction Over the past 30 years the population of end-stage renal disease (ESRD) patients has aged; the average age of starting dialysis is 67. Many have significant comorbidities, and the benefit for frail patients or those over 80 starting dialysis is uncertain. Despite this, when older patients with ESRD are admitted to hospital as an emergency, few have an advance care plan or resuscitation decision. The Nephrologists in our hospital recognised that many of these patients might benefit from an out-patient Geriatrician review. Methods The Renal Low Clearance Clinic in Leeds assesses patients with ESRD who are approaching dialysis or conservative management. A Geriatrician was established within this setting, seeing patients in an alternate-week clinic. A collaborative approach with the pre-dialysis nurses led to identification of appropriate older patients. This work has been described elsewhere (KimeZ et al, abstract accepted for UK Kidney Week 2019.) Use of comprehensive geriatric assessment (CGA) allowed for sensitive exploration of long-term goals, with discussions regarding plans in relation to renal replacement therapy and resuscitation, as well as generating continence, falls and memory clinic referrals. Where possible, family were involved. Results 43 patients had completed encounters, with an average age of 79 (range 67-90.) The median Rockwood Frailty Score was 4 (range 1-7). 29 patients were seen at one visit, the rest requiring 2 or 3 appointments. Prior to the encounter, only 2 patients had a DNACPR decision in place. Following this, 42 patients had had a resuscitation discussion and 18 patients chose DNACPR. Initially, only 7 patients had already chosen conservative management; this increased to 21 following discussions, including 7 who had previously opted for dialysis, the other 7 having been undecided. Those choosing conservative management were referred on to a specialist Renal-Palliative Care clinic. Conclusions Introducing a Geriatrician into the Low Clearance clinic has been welcomed by Renal colleagues and the effect has been apparent, with increasingly challenging patients being referred. CGA and advance care planning is feasible in this setting, which should have beneficial outcomes for patients in the longer term.

scholarly journals Validation of the Psychometric Properties of the Malay Advance Care Planning Questionnaire

2020 ◽  
Author(s):  
Mun Kit Lim ◽  
Pauline Siew Mei Lai ◽  
Pei Se Wong ◽  
Sajaratulnisah Othman ◽  
Fadzilah Hanum Mohd Mydin
Keyword(s):  
Factor Analysis ◽  
Psychometric Properties ◽  
Advance Care Planning ◽  
Response Rate ◽  
Factor Model ◽  
Tertiary Education ◽  
Primary Care Clinic ◽  
Care Planning ◽  
Care Clinic ◽  
Advance Care

Abstract Background There is a growing interest among the developing countries on advance care planning (ACP) due to the reported benefits of planning ahead in the developed countries. Validated instruments in various languages have been developed to facilitate study on the views of public prior to its implementation. However, instrument to explore the views on ACP in Malay has not been developed and validated yet, even though Malay is spoken extensively by approximately 220 million people in the Malay Archipelago. There is also a need for instrument in Malay language to facilitate the assessment of knowledge, attitude and practice (KAP) of Malaysians regarding ACP. Therefore, the aim of this study was to validate the psychometric properties of the Malay Advance Care Planning Questionnaire (ACPQ-M). Methods The ACPQ was translated according to international guidelines. This validation study was conducted from January to June 2018. Participants who were ≥21 years old, and able to understand Malay were recruited from an urban primary care clinic and a tertiary education institution in Malaysia. A researcher administered the ACPQ-M to participants via a face-to-face interview at baseline and two weeks later. Each interview took approximately 15-20 minutes. Results A total of 222/232 participants agreed to participate (response rate=96.0%). Exploratory factor analysis and confirmatory factor analysis found that the ACPQ-M was a 4-factor model. The Cronbach’s α values for the four domains ranged from 0.674-0.947. Only 157/222 participants completed the test-retest (response rate=71%). At test-retest, quadratic weighted kappa values for all domains ranged from 0.340-0.674, except for two domains which ranged from -0.200-0.467. Conclusions The ACPQ-M was found to be a 4-factor model, and a valid and reliable instrument to assess the KAP regarding ACP. This instrument can contribute to profound understanding of the KAP of Malaysians regarding ACP, and assist policy makers in determining the readiness for legislation of ACP in Malaysia.

scholarly journals Cross cultural adaptation and validation of the Malay Advance Care Planning Questionnaire

2020 ◽  
Author(s):  
Mun Kit Lim ◽  
Pauline Siew Mei Lai ◽  
Pei Se Wong ◽  
Sajaratulnisah Othman ◽  
Fadzilah Hanum Mohd Mydin
Keyword(s):  
Factor Analysis ◽  
Advance Care Planning ◽  
Response Rate ◽  
Factor Model ◽  
Tertiary Education ◽  
Primary Care Clinic ◽  
Developed Countries ◽  
Care Planning ◽  
Care Clinic ◽  
Advance Care

Abstract Background There is a growing interest among the developing countries on advance care planning (ACP) due to the reported benefits of planning ahead in the developed countries. Validated instruments in various languages have been developed to facilitate study on the views of public prior to its implementation. However, instrument to explore the views on advance care planning (ACP) in Malay has not been developed and validated yet, even though Malay is spoken extensively by approximately 220 million people in the Malay Archipelago. There is also a need for instrument in Malay language to facilitate the assessment of knowledge, attitude and practice (KAP) of Malaysians regarding advance care planning (ACP). Therefore, the purpose of this study is to cross-culturally adapt, and examine the internal consistency and reliability of the Malay Advance Care Planning Questionnaire (ACPQ-M) among the Malay speaking community dwellers.Methods The ACPQ was translated according to international guidelines. This validation study was conducted from January to June 2018. Participants who were ≥21 years old, and able to understand Malay were recruited from an urban primary care clinic and a tertiary education institution in Malaysia. A researcher administered the ACPQ-M to participants via a face-to-face interview at baseline and two weeks later. Each interview took approximately 15-20 minutes.Results A total of 222/232 participants agreed to participate (response rate=96.0%). Exploratory factor analysis and confirmatory factor analysis found that the ACPQ-M was a 4-factor model. The Cronbach’s α values for the four domains ranged from 0.674-0.947. Only 157/222 participants completed the test-retest (response rate=71%). At test-retest, quadratic weighted kappa values for all domains ranged from 0.340-0.674, except for two domains which ranged from -0.200-0.467.Conclusions The ACPQ-M was found to be a 4-factor model, and a valid and reliable instrument to assess the KAP regarding ACP. This instrument can contribute to profound understanding of the KAP of Malaysians regarding ACP, and assist policy makers in determining the readiness for legislation of ACP in Malaysia.

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