Quality Improvement Project for Advance Care Planning Tool in Hospital Medicine

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

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.

Study Overview

• Status: Completed
• Conditions: Advance Care Planning
• Intervention / Treatment: Other: Advance Care Planning Discussion

• Study Type: Observational
• Enrollment (Actual): 743

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Durham, North Carolina, United States, 27705
      • Duke University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

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.

Description

Inclusion Criteria:

• All patients admitted to the inpatient medicine service with high risk of mortality.

Exclusion Criteria:

• Involuntary commitment during the index admission

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
High risk of mortality; Adult patients admitted to the hospital medicine service with a high risk of mortality	Other: Advance Care Planning Discussion; 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.
High risk of mortality (pre-implementation); Adult patients admitted to the hospital medicine service with a high risk of mortality

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Duke University
• Investigators: Principal Investigator: Sendak Mark, Duke University

Study record dates

Study Major Dates

• Study Start (Actual): November 26, 2019
• Primary Completion (Actual): September 15, 2021
• Study Completion (Actual): March 15, 2022

Study Registration Dates

• First Submitted: March 3, 2020
• First Submitted That Met QC Criteria: March 3, 2020
• First Posted (Actual): March 5, 2020

Study Record Updates

• Last Update Posted (Actual): May 18, 2022
• Last Update Submitted That Met QC Criteria: May 11, 2022
• Last Verified: May 1, 2022

More Information

Terms related to this study

• Other Study ID Numbers: Pro00104527

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No