Teaching our Colleagues Core Palliative Care Skills Strategies

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Teaching our Colleagues Core Palliative Care Skills: Strategies for Getting Traction and the OSF

Teaching our Colleagues Core Palliative Care Skills: Strategies for Getting Traction and the OSF Experience

Our ACP Program Journey

Our ACP Program Journey

ACP Facilitators • Of approximately 200 active facilitators: – 1% Physicians – 3% APP’s

ACP Facilitators • Of approximately 200 active facilitators: – 1% Physicians – 3% APP’s – 65% Registered Nurses – 25% Social Workers – 5% Pastoral Care – 1% Other

Course Overview Pre-Course: Video demo of ACP Introductory materials including the ACP discussion guide

Course Overview Pre-Course: Video demo of ACP Introductory materials including the ACP discussion guide Didactic: 2. 5 hours of didactic content, including ethics Simulations: 4 scenarios with actors playing patient or family in the simulated outpatient setting Debriefings: After each scenario with small group After all scenarios with large group

Basic Flow of Actor Simulation 6

Basic Flow of Actor Simulation 6

Course Metrics on Addition of Simulation • Knowledge Change • Change in Confidence Pre-Post-Delayed

Course Metrics on Addition of Simulation • Knowledge Change • Change in Confidence Pre-Post-Delayed • Numbers of ACPs completed by learners

Self-ratings of competence in having discussions about values and goals. Delayed rating was at

Self-ratings of competence in having discussions about values and goals. Delayed rating was at 30 -90 days post course. N = 65, and 40 learners at pre, post, and delayed time points. Bond, W. F. , et al. J Palliat Med 20 (6): 631 -637.

Self-ratings of competence in having discussions about advance directives. Bond, W. F. , et

Self-ratings of competence in having discussions about advance directives. Bond, W. F. , et al. J Palliat Med 20 (6): 631 -637.

Post-course • Barriers identified to doing ACP after training – Logistics – Billing –

Post-course • Barriers identified to doing ACP after training – Logistics – Billing – Time – Confidence – Others

Return on Investment • Financial – Not inclusive of billing revenue • Non-financial –

Return on Investment • Financial – Not inclusive of billing revenue • Non-financial – Awards – Publications – Presentations

In the 12 months prior to death, the ACP group had a higher proportion

In the 12 months prior to death, the ACP group had a higher proportion of HCPOA completed and captured in the EMR: 320/325 (98. 5%) compared to the control group 243/325 (74. 8%) (Odds ratio (OR): 21. 6, 95% CI 8. 6, 54. 1, p<0. 001). In addition, the ACP group had a higher proportion of POLST completed and captured in the EMR: 172/325 (52. 9%) compared to the control group 145/325 (44. 6%) (OR: 1. 40, 95%CI 1. 02, 1. 90, p=0. 034). Adjusted results were similar with an odds ratio of 22. 6 for HCPOA and 1. 39 for POLST.

 Cost of ACP Education Program Cost ($)b Number of ACPs done (person) Weighted

Cost of ACP Education Program Cost ($)b Number of ACPs done (person) Weighted average cost per ACP ($) c Execution cost ($) Maintenance cost of program ($) Start-up cost ($) Total ACP intervention cost ($) Benefit of ACP Reduced expenditure of last 12 months of life per patient ($) Number of patients died (person) Total benefit of ACP intervention ($) Return on investment (ROI) Total cost ($) Net benefit (Total benefit-total cost) ($) Return on Investment A B C D=B*C E 2013 2014 2015 2016 a $43, 980 4672 $120, 054 $42, 932 3985 $159, 047 $56, 791 4448 $155, 015 $18, 237 1489 $49, 282 $161, 941 14, 594 $29. 54 $431, 107 $483, 398 F G=A+D+E+F H $438, 724 $1, 515, 170 $9, 500 I J=H*I K=G L=J-K M=(L/K)*100 325 $3, 087, 500 $1, 515, 170 $1, 572, 330 104% Bond et al. J Palliat Med 21 (4): 489 -502. Total a. 2016 is a partial year of Jan-Apr. b. Education costs increased slightly with the addition of simulation. c. Weighted average costs reflects that the majority of ACPs were facilitated by nurses and social workers. Abbreviations: ACP = Advance Care Planning. ROI = Return on Investment

Key Elements for Success • • • Executive support Accountability Education Integration in to

Key Elements for Success • • • Executive support Accountability Education Integration in to EMR Dedicated FTE’s