PLANNING FOR THE SILVER TSUNAMI: QUALITY IMPROVEMENT PROJECT ON HEALTH CARE PROXY COMPLETION

摘要

A program aimed to train primary care physicians in advance care planning (ACP) was implemented with funding from the New York Foundation for Elder Care. This training program focused on enhancing communication skills around prognosis and treatment options, as well as clarification of the older adult’s wishes given these options. A chart review to evaluate this training program in 100 ambulatory care (AC) and 88 home care (HC) patients was performed in 2017, and again in 88 AC and 88 HC patients in 2018. Repeated chart review in the same group of patients allowed examination of the completion rates of health care proxies after a year of training on advance care planning. Variables evaluated included age (66–103 M =82), cognitive impairment (41%), FAST score (24% 4–7), psychiatric diagnosis (43%), marital status (20% married), preferred language (80% English) and gender (85% female). There was an increase in the completion health care proxies (HCP) from 2017 to 2018 in both the AC practice (46% to 72 %) and HC practice (45% to 59%). Moreover, while women (p= .007) and those with mild cognitive impairment (p=036) were more likely to complete a HCP in 2017, this was not the case in 2018. There was, however, an increasing number of men (30% increase) and an increasing number of individuals without MCI a (10% increase) who completed an HCP in 2018 relative to 2017. Recommendations include encouraging continued training of physicians on the importance of documentation of ACP conversations in the wider primary care community.