SHARING Choices: Lessons Learned from a Primary-Care Focused Advance Care Planning Intervention.

MedStar author(s):
Citation: Journal of Pain & Symptom Management. 66(2):e255-e264, 2023 Aug.PMID: 37100306Institution: MedStar Health Research Instite | MedStar Institute for Quality and Safety | Palliative CareDepartment: AVP, Palliative Care | Clinical Care Transformation | MedStar Health | MedStar Health Performance ImprovementForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Advance Care Planning | *Alzheimer Disease | Aged | Communication | Humans | Medicare | Research Design | United States | Year: 2023Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0885-3924
Name of journal: Journal of pain and symptom managementAbstract: BACKGROUND: Few advance care planning (ACP) interventions have been scaled in primary care.INTERVENTION: SHARING Choices (NCT#04819191) is a multicomponent cluster-randomized pragmatic trial conducted at 55 primary care practices from two care delivery systems in the Mid-Atlantic region of the U.S. We describe the process of implementing SHARING Choices within 19 practices randomized to the intervention, summarize fidelity to planned implementation, and discuss lessons learned.KEY MESSAGE: Implementing a multicomponent, primary-care focused ACP intervention across two health systems requires adaptability, alignment with operational priorities, and workflow re-design to match the organizational structure of health systems.LESSONS LEARNED: Study findings reinforce the value of adaptable study design; co-designing workflow adaptations with practice staff; adapting implementation processes to fit the unique needs of two health systems; and modifying efforts to meet health system goals and priorities. Copyright 2023. Published by Elsevier Inc.OUTCOMES: Embedding SHARING Choices involved engagement with organizational and clinic-level partners. Of 23,220 candidate patients, 17,931 outreach attempts by phone (77.9%) and the patient portal (22.1%) were made by ACP facilitators and 1,215 conversations occurred. Most conversations (94.8%) were less than 45 minutes duration. Just 13.1% of ACP conversations included family. Patients with ADRD comprised a small proportion of patients who engaged in ACP. Implementation adaptations included transitioning to remote modalities, aligning ACP outreach with the Medicare Annual Wellness Visit, accommodating primary care practice flexibility.PROBLEM: Best practices for delivering ACP at scale in primary care do not exist and prior efforts have excluded older adults with Alzheimer's Disease and Related Dementias (ADRD).All authors: Anderson RE, Boyd CM, Chapin M, Cockey K, Colburn JL, Cotter V, Dy SM, Echavarria D, Giovannetti ER, Hussain N, McGuire M, Nicholson KLC, Rawlinson C, Rebala S, Roth DL, Sancho MB, Saylor MA, Scerpella DL, Sharma N, Smith KM, Walker KA, Wolff JLOriginally published: Original year of publication: 2023Fiscal year: Fiscal year of original publication: FY2023Digital Object Identifier:
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 37100306 Available 37100306

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: Few advance care planning (ACP) interventions have been scaled in primary care.

INTERVENTION: SHARING Choices (NCT#04819191) is a multicomponent cluster-randomized pragmatic trial conducted at 55 primary care practices from two care delivery systems in the Mid-Atlantic region of the U.S. We describe the process of implementing SHARING Choices within 19 practices randomized to the intervention, summarize fidelity to planned implementation, and discuss lessons learned.

KEY MESSAGE: Implementing a multicomponent, primary-care focused ACP intervention across two health systems requires adaptability, alignment with operational priorities, and workflow re-design to match the organizational structure of health systems.

LESSONS LEARNED: Study findings reinforce the value of adaptable study design; co-designing workflow adaptations with practice staff; adapting implementation processes to fit the unique needs of two health systems; and modifying efforts to meet health system goals and priorities. Copyright 2023. Published by Elsevier Inc.

OUTCOMES: Embedding SHARING Choices involved engagement with organizational and clinic-level partners. Of 23,220 candidate patients, 17,931 outreach attempts by phone (77.9%) and the patient portal (22.1%) were made by ACP facilitators and 1,215 conversations occurred. Most conversations (94.8%) were less than 45 minutes duration. Just 13.1% of ACP conversations included family. Patients with ADRD comprised a small proportion of patients who engaged in ACP. Implementation adaptations included transitioning to remote modalities, aligning ACP outreach with the Medicare Annual Wellness Visit, accommodating primary care practice flexibility.

PROBLEM: Best practices for delivering ACP at scale in primary care do not exist and prior efforts have excluded older adults with Alzheimer's Disease and Related Dementias (ADRD).

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