improving inpatient advance care planning: a quality improvement study
TRANSCRIPT
Improving Inpatient Advance Care Planning
Medical Order for Scope of Treatment
(MOST) Implementation
Dr. Samuel Kohen
Comox, BC
BC Quality Forum March 2, 2017 – 10:00 to 11:00 AM
Breakout Session – A5
Disclosures…
No conflicts of interest
What is Advance Care Planning
ACP Engagement: How are we doing?
What is the evidence for ACP?
Quadruple Aim Provider Experience
Project objectives:
• Implement the MOST at SJGH • Organizational uptake
• Compare DNR with MOST
• Discordance • Patient Satisfaction • Health care utilization
Key Steps: MOST Development
(Jun 2015 – Mar 2016)
MOST Implementation (May – June 2016)
ACP Data Collection (May 2016 – Ongoing)
Project Lead
Hospital staff
Managers, Charge nurses
Physicians
General and departmental
meetings
Patients
Posters, Handouts
VIHA Administration
Hospital Administration
Project administration
Study Overview
ER Admission Discharge 3 month
Follow-up
Patient consent (Hd1)
Hospital data collection • Patient questionnaires • Chart review
Follow-up data collection • Mortality • Health care utilization
Methods: Inclusion/Exclusion
Inclusion Criteria Exclusion Criteria
Project Measures
1) MOST Uptake 2) Discordance 3) Patient Satisfaction 4) Health Care Utilization
Results: Patient Demographics
Demographic Result
Patients (n) 361
Age (mean) 72 years
Gender (female) 51%
Charlson Comorbidity Index (mean) 3.6
AHRP 61%
Admission Diagnosis CHF (30%), OA (16%), COPD (15%), HTN (14%), Cancer (9%), Dementia (4%)
Admission Unit Medical (25%), Surgical (57%), Telemetry (10%), ICU (9%)
Summary statistics valid up to and including January, 2017
Results: MOST Uptake
0
10
20
30
40
50
60
70
80
90
100
May Jun Jul Aug Sep Oct Nov Dec Jan
% A
CP
Co
mp
leti
on
Documentation of Inpatient Advance Care Planning
MOST by Hd3
ACP Completion Pre-MOST
Results: Discordance
=?
0.00
0.50
1.00
1.50
2.00
2.50
3.00
May Jun Jul Aug Sep Oct Nov Dec Jan
Leve
l of
Dis
cord
ance
Discordance between Patient Wishes and Documentation
All cases
MOST Completed
MOST NOT Completed
Results: Patient Satisfaction
CanHelp Lite: Patient Satisfaction Questionnaire
3.7
3.8
3.9
4.0
4.1
4.2
4.3
4.4
May Jun Jul Aug Sep Oct Nov Dec Jan
Sati
sfac
tio
n
Patient Satisfaction with Advance Care Planning (CanHELP Lite)
Results: Health Care Utilization
Key Points:
MOST > DNR Strategy is important
Challenges and Successes
Organizational transition: • VIHA administrative structure • Hospital absorption into VIHA • New physical space
Teamwork: • 100% MOST uptake!
Future Directions:
Video patient engagement tool
Island wide ACP coordination
Provincial alignment
Thank You Project Funding
Political Support
Project Members Project Manager: Dr. Rajesh Nair Project Technicians: Ms. Barbara Mcdowell (SW), Ms. Melissa Moskaluk (SW), Mr. Erik Williams (SW) Video scriptwriters: Ms. Mary Lee, Ms. Cari Hoffman Focus Group: Ms. Dawn Dompierre, Dr. Leah McDonald, Dr. Doris Barwich, Dr. Patricia Murphy, Dr. Peter Moosbruger Advisory Committee: Dr. John You, Dr. Leah McDonald, Dr. Izak Benbasat
Technical Support
Contact Information: [email protected]
