A Group Visit Initiative Improves Advance Care Planning Documentation among Older Adults in Primary Care

Lum, Hillary D.; Sudore, Rebecca L.; Matlock, Daniel D.; Juaréz-Colunga, Elizabeth; Jones, Jacqueline; Nowels, Molly; Schwartz, Robert S.; Kutner, Jean S.; Levy, Cari

doi:10.3122/jabfm.2017.04.170036

Cited by 36 publications

(46 citation statements)

References 39 publications

(45 reference statements)

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“…19 Understanding how to support primary care practices to routinely incorporate ACP conversations are critical areas for research and policy initiatives. Several creative approaches to expand these conversations are being explored, including development of a Serious Illness Conversation Guide for use in primary care settings, 32 exploration of group visits models focused on ACP conversations, 33 and web sites that guide patients and their loved ones through initial ACP conversations and create documents that can be uploaded into electronic health records via patient portals. 34 Our study demonstrates how evidencebased tools to support ACP conversations may have enhanced reach and effectiveness when implemented in higher quality primary care practices.…”

Section: Discussionmentioning

confidence: 99%

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

Nowels

Sheffler

et al. 2019

J Am Board Fam Med

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Introduction: Primary care practices are essential settings for Advance Care Planning (ACP) conversations with patients. We hypothesized that such conversations occur more routinely in Advanced Primary Care/Patient Centered Medical Home (APCP/PCMH) Practices using practice transformation strategies. Methods: We analyzed characteristics of physician respondents and their practices associated with ACP discussions in older and sicker patients using US data from the 2015 Commonwealth Fund International Survey of Primary Care Physicians in 10 Nations. The primary outcome was how routinely these ACP conversations are reported. We developed an index of APCP/PCMH features as a practice covariable. Results: Respondents (N ‫؍‬ 1001) were predominantly male (60%) and >45 years old (74%). Multivariable analyses showed that suburban practice location was associated with fewer ACP conversations; working in a practice commonly seeing patients with multiple chronic conditions or who have palliative care needs, and working in a practice from which home visits are made, were associated with more ACP conversations. Physicians compensated in part by capitation were more likely to report ACP conversations. No association was found between a single item asking if the practice was an APCP/PCMH and having ACP conversations. However, higher scores on an index of APCP/PCMH features were associated with more ACP conversations. Conclusions: In this sample of US primary care physicians, the types of patients seen, practice location, and physician compensation influenced whether physicians routinely discuss ACP with patients who are older and sicker. Practices demonstrating more features of APCP/PCMH models of primary care are also associated with ACP discussions.

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Section: Discussionmentioning

confidence: 99%

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

Nowels

Sheffler

et al. 2019

J Am Board Fam Med

Self Cite

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“…The supportive atmosphere of groups can also alleviate anxieties veterans may have when discussing this potentially complex and emotional topic individually with a healthcare provider or significant other. Furthermore, clinical staff members who lead the groups have more time to engage veterans about their preferences and can use the group dynamic to model open dialog with veterans, peers, and trusted others [17,18].…”

Section: Challenges Of Advance Care Planningmentioning

confidence: 99%

Evaluation of the national implementation of the VA Diffusion of Excellence Initiative on Advance Care Planning via Group Visits: protocol for a quality improvement evaluation

Matthieu

Ounpraseuth

Painter

et al. 2020

Implement Sci Commun

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Background: Traditionally, system leaders, service line managers, researchers, and program evaluators hire specifically dedicated implementation staff to ensure that a healthcare quality improvement effort can "go to scale." However, little is known about the impact of hiring dedicated staff and whether funded positions, amid a host of other delivered implementation strategies, are the main difference among sites with and without funding used to execute the program, on implementation effectiveness and cost outcomes. Methods/design: In this mixed methods program evaluation, we will determine the impact of funding staff positions to implement, sustain, and spread a program, Advance Care Planning (ACP) via Group Visits (ACP-GV), nationally across the entire United States Department of Veterans Affairs (VA) healthcare system. In ACP-GV, veterans, their families, and trained clinical staff with expertise in ACP meet in a group setting to engage in discussions about ACP and the benefits to veterans and their trusted others of having an advance directive (AD) in place. To determine the impact of the ACP-GV National Program, we will use a propensity score-matched control design to compare ACP-GV and non-ACP-GV sites on the proportion of ACP discussions in VHA facilities. To account for variation in funding status, we will document and compare funded and unfunded sites on the effectiveness of implementation strategies (individual and combinations) used by sites in the National Program on ACP discussion and AD completion rates across the VHA. In order to determine the fiscal impact of the National Program and to help inform future dissemination across VHA, we will use a budget impact analysis. Finally, we will purposively select, recruit, and interview key stakeholders, who are clinicians and clinical managers in the VHA who offer ACP discussions to veterans, to identify the characteristics of high-performing (e.g., high rates or sustainers) and innovative sites (e.g., unique local program design or implementation of ACP) to inform sustainability and further spread.

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“…The supportive atmosphere of groups can also alleviate anxieties Veterans may have when discussing this potentially complex and emotional topic individually with a healthcare provider or significant other. Furthermore, clinical staff members who lead the groups have more time to engage Veterans about their preferences and can use the group dynamic to model open dialogue with Veterans, peers, and trusted others [16,17].…”

Section: Use Of Paid Staff As Implementation Strategymentioning

confidence: 99%

Evaluation of the national implementation of the VA Diffusion of Excellence Initiative on Advance Care Planning via Group Visits: Protocol for a quality improvement evaluation

Matthieu

Ounpraseuth

Painter

et al. 2020

Preprint

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Background Traditionally system leaders, service line managers, researchers, and program evaluators, hire specifically dedicated implementation staff to ensure that a healthcare quality improvement effort can “go to scale”. However, little is known about the impact of hiring dedicated staff and whether funded positions, amid a host of other delivered implementation strategies, is the main difference among sites with and without funding used to execute the program, on implementation effectiveness and cost outcomes. Methods/Design In this mixed methods program evaluation, we will determine the impact of funding staff positions to implement, sustain, and spread a program, Advance Care Planning (ACP) via Group Visits (ACP-GV), nationally across the entire United States Department of Veterans Affairs (VA) healthcare system. In ACP-GV, Veterans, their families, and trained clinical staff with expertise in ACP meet in a group setting to engage in discussions about ACP and the benefits to Veterans and their trusted others of having an Advance Directive (AD) in place. To determine the impact of the ACP-GV National Program, we will use a propensity score matched control design to compare ACP-GV and non-ACP-GV sites on the proportion of ACP discussions in VHA facilities. To account for variation in funding status, we will document and compare funded and unfunded sites on the effectiveness of implementation strategies (individual and combinations) used by sites in the National Program on ACP discussion and AD completion rates across the VHA. In order to determine the fiscal impact of the National Program and to help inform future dissemination across VHA, we will use a budget impact analysis. Finally, we will purposively select, recruit, and interview key stakeholders, who are clinicians and clinical managers in the VHA who offer ACP discussions to Veterans, to identify the characteristics of high-performing (e.g., high rates or sustainers) and innovative sites (e.g., unique local program design or implementation of ACP) to inform sustainability and further spread. Discussion As an observational evaluation, this protocol will contribute to our understanding of implementation science and practice by examining the natural variation in implementation and spread of ACP-GV with or without funded staff positions.

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A Group Visit Initiative Improves Advance Care Planning Documentation among Older Adults in Primary Care

Cited by 36 publications

References 39 publications

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

Evaluation of the national implementation of the VA Diffusion of Excellence Initiative on Advance Care Planning via Group Visits: protocol for a quality improvement evaluation

Evaluation of the national implementation of the VA Diffusion of Excellence Initiative on Advance Care Planning via Group Visits: Protocol for a quality improvement evaluation

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