How do you prepare your patient to die? How do you ease his or her family’s pain, and help them understand the reality of the situation? No medical professional looks forward to an end-of-life discussion, but advanced care planning is a necessary part of the care process.
A few years ago, I had an interesting conversation with a group of primary care physicians about advanced care planning. All of the physicians in the group had patients who were being cared for by a hospitalist group. Despite the fact that their patients were being cared for by someone else, all of the primary physicians believed that they should handle the end-of-life conversation.
When I showed the physicians the real-life statistics on ‘their’ patients, the room fell silent. The data showed that a notable number of their patients were discharged from an inpatient stay and died on a readmission within seven days of the index admission.
Their patients did not live long enough to have a follow-up appointment with them, and as a result, they missed the opportunity to have an advanced care planning conversation. Approximately 97 percent of the general public thinks that medical professionals should have advanced care planning conversations with their patients. So, why do they think advanced care planning is so important? And how can it impact a person, family or society? The statistics say it all:
- Patients who are admitted to hospice at an earlier stage are more likely to live longer;
- Approximately 30 percent of patient end-of-life wishes are misinterpreted by the medical power of attorney;
- Hospice use extended the 18-month survival rate of the widowed spouse compared to widows/widowers whose spouses were not enrolled in hospice; and
- Longer hospice enrollment decreases the likelihood of caregiver depression.
Even though the benefits of advanced care planning cannot be denied, so many individuals still miss out on the opportunity to clearly state their wishes for their end-of-life care. For some, advanced care planning may be in conflict with spiritual or cultural values. For others, it is a latent defect in our healthcare system that is just waiting to become an active error in patient care.
So, how can you ensure that your patients receive the advanced care planning that they need?
Here are seven ideas to help get you started:
- Determine your current mortality state by creating a dashboard that includes your value-based purchasing mortality index baseline, benchmarks and targets.
- Analyze your data. PremierConnect® Quality analytics can provide valuable insights into a wealth of information on who your dying patients are; who is discharged and returns to die; which providers are proactively engaging patients in advanced care planning; which diagnoses are most at risk for death; peer adjusted comparisons of the use of palliative care in your patients; and much more.
- Identify and prioritize opportunities based on your dashboard and determine where your advanced care planning gaps are, based on best practices. Ask yourself these questions: Do you have a palliative care screening tool? Do you have palliative care involved in interdisciplinary rounds? Are your providers and nursing homes involved in advanced care planning? Is there a mechanism for advanced directives to be communicated across the continuum of care?
- Seek out education about advanced care planning. A great place to start is the National Institutes of Health’s National Institute on Aging.
- Coordinate with your practice setting policy makers to ensure advanced care planning conversations are not put on hold waiting for the right person (rather, bring the right person to the patient in real-time, perhaps by extending the number of ‘right people’).
- Complete your own advanced directive and discuss it with your loved ones.
New in 2016: CMS provides reimbursement for advanced care planning. Get the details at minute 39:52 of this recorded webinar from Premier.