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In the context of #COVID19, never has advance care planning ( #ACP) felt so necessary and relevant to more people; yet, so elusive in how to actually do #ACP at scale. @JaredLowe18 and I want to share everything we've learned doing exactly this. http://ow.ly/816J50z5TFe
Our goal was to design and implement a scalable, patient-centered workflow for #ACP in our primary care practice. We share everything we learned and created including outreach scripts, education cards, note templates, and elements of the algorithm. Please modify, use, and share!
There are numerous challenges to engaging a population of primary care patients in #ACP and doing so at scale including:
1/ Identification of patients who would most benefit from ACP;
2/ Outreach and engagement of patients and caregivers in a challenging topic;
1/ Identification of patients who would most benefit from ACP;
2/ Outreach and engagement of patients and caregivers in a challenging topic;
3/ Design of clinic workflows that enable accurate completion of ACP-associated documentation and accessibility across care settings;
4/ Patient-centered design of educational materials; and
4/ Patient-centered design of educational materials; and
5/ Expansion of clinic provider bandwidth to allow sufficient time to have comprehensive conversations with patients.
Even before #COVID19, #ACP was hard to integrate into usual outpatient practice.
Even before #COVID19, #ACP was hard to integrate into usual outpatient practice.
We addressed these challenges using a simple patient identification algorithm that relies on easily available EHR data, existing EHR functionality to share ACP data across health care settings, and patient-centered design to make a difficult topic more approachable for patients.
Here is an overview of what the pilot looked like. See the article for details and to download some discrete tools that might be helpful to you.
Here are the major takeaways:
1/ A scalable workflow to meet #ACP needs of a population of patients in the primary care setting is feasible. This can be adopted in the specialty outpatient setting. In the setting of COVID-19 they are amenable to adaptation to virtual encounters.
1/ A scalable workflow to meet #ACP needs of a population of patients in the primary care setting is feasible. This can be adopted in the specialty outpatient setting. In the setting of COVID-19 they are amenable to adaptation to virtual encounters.
2/Integrating a patient advisory council in the design of this program helped make a difficult topic more approachable for patients and their families.
3/ Simple algorithms that rely on readily available EHR data may be a starting point for identifying patients for ACP. Focus on the patient-centered workflow -- the algorithm is the least important!
4/ Patient navigators provided the necessary bandwidth for the delivery of patient-centered ACP in primary care. Skills in communication and team-based care with PCPs are most critical.
What we created here was developed in a pre #COVID19 world. As we describe the pilot and what we learned, we’ve bolded and italicized parts that deserve commentary based on present circumstances.
They may take into account the role of virtual care (i.e,, #telehealth), the need for social distancing, and the acuity of disease. We also link to excellent resources that will be helpful to clinicians: @NathanAGray @vitaltalk @AriadneLabs
In the setting of the #COVID19 pandemic, #ACP is more important now than ever. We sincerely hope these resources and tools can help clinicians, practices, and health systems design and deploy scalable workflows for #ACP.
We grant permission for you to use the resources that we developed for our pilot and to modify them to meet your needs. We also welcome your questions and comments and invite you to contribute your perspective on how to expand access to #ACP during this critical time.
We want to acknowledge Drs. Lynn Bowlby and Larry Greenblatt, Indhira Udofia and Chenita Jackson for their contributions to the pilot. We are grateful to @SocietyGIM for the opportunity to present our work at the 2018 annual meeting.
