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Evaluation of an initiative to improve advance care planning for a home-based primary care service

التفاصيل البيبلوغرافية
العنوان: Evaluation of an initiative to improve advance care planning for a home-based primary care service
المؤلفون: Michelle B. Cox, Paige Moorhouse, Katie Bauder, Margaret J. McGregor, Laurie Mallery, Madison Huggins
المصدر: BMC Geriatrics
BMC Geriatrics, Vol 21, Iss 1, Pp 1-10 (2021)
سنة النشر: 2020
مصطلحات موضوعية: Advance care planning, Resuscitation, medicine.medical_specialty, Canada, Population, Psychological intervention, Home-based primary care, Documentation, lcsh:Geriatrics, Do-not-resuscitate, Substitute decision-maker, 03 medical and health sciences, Advance Care Planning, 0302 clinical medicine, Intensive care, Health care, medicine, Humans, 030212 general & internal medicine, education, Aged, Retrospective Studies, education.field_of_study, Primary Health Care, Frailty, business.industry, Do not resuscitate, Odds ratio, humanities, lcsh:RC952-954.6, 030220 oncology & carcinogenesis, Emergency medicine, Do-not-hospitalize, Geriatrics and Gerontology, business, Research Article
الوصف: Background Advance care planning (ACP) is a process that enables individuals to describe, in advance, the kind of health care they would want in the future. There is evidence that ACP reduces hospital-based interventions, especially at the end of life. ACP for frail older adults is especially important as this population is more likely to use hospital services but less likely to benefit from resource intensive care. Our study goal was to evaluate whether an approach to ACP developed for frail older adults, known as the Palliative and Therapeutic Harmonization or PATH, demonstrated an improvement in ACP. Methods The PATH approach was adapted to a primary care service for homebound older adults in Vancouver, Canada. This retrospective chart review collected surrogate measures related to ACP from 200 randomly selected patients enrolled in the service at baseline (prior to June 22, 2017), and 114 consecutive patients admitted to the program after implementation of the PATH ACP initiative (October 1, 2017 to May 1, 2018). We compared the following surrogate markers of ACP before and after implementation of the PATH model, chart documentation of: frailty stage, substitute decision-maker, resuscitation decision, and hospitalization decision. A composite ACP documentation score that ascribed one point for each of the above four measures (range 0 to 4) was also compared. For those with documented resuscitation and hospitalization decisions, the study examined patient/ substitute decision-maker expressed preferences for do-not-resuscitate and do-not-hospitalize, before and after implementation. Results We found the following changes in ACP-related documentation before and after implementation: frailty stage (27.0% versus 74.6%, p p = 0.128); resuscitation decision documented (79.5% versus 67.5%, p = 0.018); and hospitalization decision documented (61.5% versus 100.0%, p p Conclusions Results suggest partial success in implementing the PATH approach to ACP in home-based primary care. Key contextual enablers and barriers are important considerations for successful implementation.
تدمد: 1471-2318
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::230fd893523736e31321d09c1ab5cebe
https://pubmed.ncbi.nlm.nih.gov/33530930
حقوق: OPEN
رقم الأكسشن: edsair.doi.dedup.....230fd893523736e31321d09c1ab5cebe
قاعدة البيانات: OpenAIRE
الوصف
تدمد:14712318