Scholarlink

Background <p>Advance care planning (ACP) is critical for communicating patients’ preferences for future medical care, especially in geriatric populations. Despite the acknowledged importance, completion rates remain low.</p> Objective <p>We aimed to increase ACP in a geriatric primary care clinic (geri-PCC) using a trainee-led educational intervention.</p> Design <p>Retrospective analysis of a quality improvement intervention.</p> Participants <p>In total, 498 patients, &gt; 60&#xa0;years old with no advance directives (AD) or Portable Medical Orders (POLST) were seen in the geri-PCC during the intervention period. Sixty-five received the intervention while 433 did not.</p> Intervention <p>We incorporated an ACP education session led by medical trainees into the geri-PCC workflow 3/2023–4/2023.</p> Main Measures <p>New AD (includes durable power of attorney for healthcare (dPOA) and Living Will (LW)) and POLST captured in the EMR, ICD-10 codes billed for ACP/goals of care (GOC) were compared between the intervention and standard care groups during 6 months following the intervention period. Secondary logistic regression analyses adjusted for age, gender, mood disorder, and cognitive impairment when evaluating the intervention’s association with primary outcomes.</p> Key Results <p>The intervention group had more new dPOA forms (13.8% vs 5.3%, <i>p</i> = 0.025) and ACP/GOC codes (32% vs 13%, <i>p</i> &lt; 0.001). These findings remained significant after adjusting for age, gender, mood disorder, and cognitive impairment (dPOA OR = 2.96, 95% CI 1.24–6.59, <i>p</i> = 0.010; ACP/GOC OR 3.07, 95% CI 1.67–5.52, <i>p</i> &lt; 0.001). Cognitive impairment was associated with more completion of POLST (OR = 3.29, 95% CI 1.15–11.0, <i>p</i> = 0.035) but less completion of LWs (OR = 0.34, 95% CI 0.13–0.79, <i>p</i> = 0.018).</p> Conclusions <p>Incorporating an ACP education session led by medical trainees was associated with increased AD documentation in the EMR and increased ACP/GOC codes billed in our geri-PCC. The emergence of cognitive impairment as a predictor of POLST completion needs further exploration.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Trainee-Led Patient Education to Increase Advance Care Planning in a Geriatric Primary Care Clinic

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年6月30日

查看全文
  • Zehra B. Omer,
  • Archana Sadangi,
  • Zaid Shakir,
  • Sidrah Rafiq,
  • Sakshi Jain,
  • Susan Shanthi Priya Dara,
  • Simon Gelman,
  • Manisha Parulekar

摘要

Background

Advance care planning (ACP) is critical for communicating patients’ preferences for future medical care, especially in geriatric populations. Despite the acknowledged importance, completion rates remain low.

Objective

We aimed to increase ACP in a geriatric primary care clinic (geri-PCC) using a trainee-led educational intervention.

Design

Retrospective analysis of a quality improvement intervention.

Participants

In total, 498 patients, > 60 years old with no advance directives (AD) or Portable Medical Orders (POLST) were seen in the geri-PCC during the intervention period. Sixty-five received the intervention while 433 did not.

Intervention

We incorporated an ACP education session led by medical trainees into the geri-PCC workflow 3/2023–4/2023.

Main Measures

New AD (includes durable power of attorney for healthcare (dPOA) and Living Will (LW)) and POLST captured in the EMR, ICD-10 codes billed for ACP/goals of care (GOC) were compared between the intervention and standard care groups during 6 months following the intervention period. Secondary logistic regression analyses adjusted for age, gender, mood disorder, and cognitive impairment when evaluating the intervention’s association with primary outcomes.

Key Results

The intervention group had more new dPOA forms (13.8% vs 5.3%, p = 0.025) and ACP/GOC codes (32% vs 13%, p < 0.001). These findings remained significant after adjusting for age, gender, mood disorder, and cognitive impairment (dPOA OR = 2.96, 95% CI 1.24–6.59, p = 0.010; ACP/GOC OR 3.07, 95% CI 1.67–5.52, p < 0.001). Cognitive impairment was associated with more completion of POLST (OR = 3.29, 95% CI 1.15–11.0, p = 0.035) but less completion of LWs (OR = 0.34, 95% CI 0.13–0.79, p = 0.018).

Conclusions

Incorporating an ACP education session led by medical trainees was associated with increased AD documentation in the EMR and increased ACP/GOC codes billed in our geri-PCC. The emergence of cognitive impairment as a predictor of POLST completion needs further exploration.