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Hospitalized patients and their families are often unprepared regarding end-of-life care. Even patients with high risk of mortality within the index admission or 30 days after admission often do not have clearly defined goals of care. This lack of clarity can create difficult scenarios for patients, their families, and care providers. Lack of communication and documentation of these goals can lead to unnecessary tests, procedures, and readmissions. By creating advanced care planning education for the hospital medicine department, a standardized note template, and EMR utilization for storage and reference of patient's goals of care documentation we aim to facilitate the conveyance of patient's wishes/preferences across different care providers and across separate encounters within the healthcare system. For this study, we will use a pre-post study design to evaluate the implementation of this quality improvement intervention.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| High risk of mortality | Adult patients admitted to the hospital medicine service with a high risk of mortality |
| |
| High risk of mortality (pre-implementation) | Adult patients admitted to the hospital medicine service with a high risk of mortality |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Advance Care Planning Discussion | Other | Goals of care discussion with patient, documentation with electronic health record note and advance care planning billing. This will also include: pharmacy review of medications, case management review, and coding specialist review. |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients who have advanced care planning notes completed during the admission | As measured by medical record review (Pre-implementation) | Hospital admission, up to 7 days |
| Proportion of patients who have advanced care planning notes completed during the admission | As measured by medical record review (Post-implementation) | Hospital admission, up to 7 days |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patient who have documentation utilizing the electronic health record dotphrase note template | As measured by medical record review (Pre-implementation) | Hospital admission, up to 7 days |
| Proportion of patient who have documentation utilizing the electronic health record dotphrase note template |
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Inclusion Criteria:
Exclusion Criteria:
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The study population for the QI project will include two groups (pre and post-implementation) in order to evaluate the effectiveness of the program. Both the pre-implementation and the intervention (post-implementation) groups consist of adult patients admitted to the hospital medicine service with a high risk of mortality; clinicians providing care for patients in the post-implementation group will also receive a notification of the patient's high risk of mortality and recommendation for a serious illness conversation. The evaluation has been narrowed to a pre-post study design, which will enable our team to identify the impact of the intervention.
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| Name | Affiliation | Role |
|---|---|---|
| Sendak Mark | Duke University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Duke University | Durham | North Carolina | 27705 | United States |
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As measured by medical record review (Post-implementation) |
| Hospital admission, up to 7 days |
| Proportion of patients who are billed for advanced care planning | As measured by medical record review (Pre-implementation) | Hospital admission, up to 7 days |
| Proportion of patients who are billed for advanced care planning | As measured by medical record review (Post-implementation) | Hospital admission, up to 7 days |
| Proportion of patients who receive palliative care consults | As measured by medical record review (Pre-implementation) | Hospital admission, up to 7 days |
| Proportion of patients who receive palliative care consults | As measured by medical record review (Post-implementation) | Hospital admission, up to 7 days |
| Proportion of patients who are discharged to hospice | As measured by medical record review (Pre-implementation) | Hospital discharge, up to 7 days |
| Proportion of patients who are discharged to hospice | As measured by medical record review (Post-implementation) | Hospital discharge, up to 7 days |
| Proportion of patients who have an appointment to the palliative care clinic | As measured by medical record review (Pre-implementation) | Up to 1 month |
| Proportion of patients who have an appointment to the palliative care clinic | As measured by medical record review (Post-implementation) | Up to 1 month |