Quality Improvement Project for Advance Care Planning Tool in Hospital Medicine

Study Overview
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Brief Summary
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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.

Official Title
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Quality Improvement Project: Assessing the Use of Advanced Care Planning Documentation for Patients at High Risk of 30-day Mortality on Hospital Medicine Services

Conditions
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Advance Care Planning

Intervention / Treatment
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* Other: Advance Care Planning Discussion


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients admitted to the inpatient medicine service with high risk of mortality. Exclusion Criteria: Involuntary commitment during the index admission

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| High risk of mortality<br>Adult patients admitted to the hospital medicine service with a high risk of mortality | Other: Advance Care Planning Discussion<br>* 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.<br>|
| High risk of mortality (pre-implementation)<br>Adult patients admitted to the hospital medicine service with a high risk of mortality | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | 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 | 

Secondary Outcome Measures

| Outcome Measure | 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 | 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 |