For Texas health system Houston Methodist, the major challenges to obtaining completed advance care directives included the time constraints of primary care physicians in addressing advance care planning with their patients.

THE PROBLEM

In addition, patients too often crash during a hospitalization with no advance care directives in place to guide care.

"We were seeking a solution that would use technology that would be both sensitive to patient needs and provide culturally sensitive patient education on respecting patient wishes and choices," said Dr. Julia Andrieni, senior vice president of population health and primary care at Houston Methodist, and president and CEO of Houston Methodist Coordinated Care ACO and HMPAQ.

"With limited staffing, we also wanted to use a tool that would be both efficient and effective," she continued. "Koda Health has a user-friendly tool that our nursing team could use, and patients could use in the comfort of their homes with the time needed to make thoughtful decisions with their families."

PROPOSAL

Koda Health is a vendor of an advance care planning software platform. Initially, Houston Methodist planned to pilot the technology, because it had not seen any other type of technology that could address this issue in a sensitive manner.

"We did not know what we would learn, but were willing to try, as we did not have a solution to increase our advance care planning for a growing Medicare population," Andrieni noted.

MEETING THE CHALLENGE

To operationalize the new technology, the health system decided to use its palliative nurse team, which already was working with the advance care Medicare population. Many of these patients did not have advance care planning in place.

"Pairing technology with a nurse optimizes the use of a platform as well as achieves and advances strategic goals to increase advance care planning in a growing population."

Dr. Julia Andrieni, Houston Methodist

"We have since expanded the use of this platform to other nursing teams to address with their patients to expand this initial strategic effort," Andrieni said. "These nurses work with patients to complete and answer their questions to construct a comprehensive, long-term care plan that honors individual patients’ wishes.

"We scan completed forms into EHRs to share with the medical teams," she added.

RESULTS

Houston Methodist has increased the number of patients educated on advance care planning and the number of patients engaged to complete and notarize their advance care plans.

"In addition, when we reviewed the data, we found a higher percentage of patient engagement and completion of ACPs was achieved, compared with the traditional method within the primary care physician office or hospital," Andrieni reported.

"In addition, when using this type of technology in the convenience of patients’ homes, with the facilitation by a nursing professional, the percentages of men and of people of color were higher than national averages for ACP completion," she noted.

ADVICE FOR OTHERS

Other health systems should consider using technology strategically to increase patient education and patient engagement in completing advance care plans, Andrieni advised.

"Giving patients time within their homes with their families to make tough choices is an optimal method that cannot be achieved in the 10 or 20 minutes people have during a primary care physician visit," she concluded. "In addition, pairing technology with a nurse optimizes the use of a platform, as well as achieves and advances strategic goals to increase advance care planning in a growing population."

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