Advance Care Planning Primary Care Collaborative Katherine Aragon
Advance Care Planning Primary Care Collaborative Katherine Aragon, MD, Assistant Professor, Palliative Care Program, Division of General Medicine and Clinical Epidemiology Karen Halpert, MD, Assistant Professor, Department of Family Medicine 09. 15. 2020 UNC Health
09. 15. 2020 UNC Health
QIOC Ambulatory Care Organizational Goal Percentage of patients aged 65 years and older seen in last 12 months with one of the following documented: • Active code status OR • Health care decision maker (HCDM) OR • ACP note OR • Scanned Advance Directive *Triangle Ambulatory Target for FY 20 = 64% 09. 15. 2020 UNC Health
Project Aim Global Aim: To develop a standardized, interdisciplinary process for introducing, discussing and documenting advance care planning in ambulatory care clinics. Aim 1: Increase healthcare decision maker documentation by 50% for patients 65 years or older in 4 primary care clinics by Aug 31, 2020. Aim 2: Increase ACP Notes by 25% for patients 65 years or older in 4 primary care clinics by Aug 31, 2020. 09. 15. 2020 UNC Health
Collaborative Model Chapel Hill Internal Medicine- PN Clinic UNC Family Medicine Chapel Hill UNC Internal Medicine Chapel Hill UNC Family Medicine Durham 09. 15. 2020 UNC Health
PDSAs for HCDM- A role for everyone UNC Internal Medicine Chapel Hill: Front Desk, MA, RN • Intake Form • Ask and document on rooming UNC Family Medicine Durham: Front Desk, MA • • 09. 15. 2020 Verify/Enter Emergency Contact Ask and document on rooming UNC Family Medicine Chapel Hill- SW, RN • • Ask and document during Transitions Clinic Ask and document during outreach calls Chapel Hill Internal Medicine: RN, MD/APPs • Education and encouragement to ask and document on rooming or during visit. UNC Health
Health Care Decision Maker (HCDM): Standardized process successful 09. 15. 2020 UNC Health
Advance Care Planning (ACP) Notes: Trying to standardized a complex process 09. 15. 2020 UNC Health
ACP Dashboard- Collaborating with analyst to improve usability 09. 15. 2020 UNC Health
Quality Conversations and ACP Notes Our goal: Promote quality values-based ACP conversations for patients who are at higher risk for decline and may benefit most from ACP. What we are working on: • Developing a script for ACP introduction • Asking providers to identify patients who may benefit most from ACP • Scheduling ACP visits vs incorporating in to already scheduled visits • Encouraging participation in ACP and Serious Illness Conversation courses Challenges: • Provider Time/Billing concerns • Identifying patients in a systematic way • Varying comfort with conversations 09. 15. 2020 UNC Health
Thank you! Collaborative Team: Karen Bell, RN, Chapel Hill Internal Medicine Michele Gibson, RN, UNC Family Medicine Durham Amy Prentice, MSW, UNC Family Medicine Chapel Hill Julia Tompkins, MSW, UNC Internal Medicine Chapel Hill Deanna Zolfo, PCIC/QI Coach Collin Burks, MD/PGY 2, UNC Family Medicine Nancy Mc. Elveen, Patient and Family Advisory Council Project Manager: Laura Brown, MPH Project Mentor: Shana Ratner, MD Project Sponsor: Tommy Koonce, MD ACP Dashboard Specialist: Tristan Long, MBA 09. 15. 2020 Questions/Comments UNC Health
- Slides: 11