TY  - BOOK
AU  - Anderson, Ryan E
AU  - Cockey, Kimberly
AU  - Dy, Sydney M
AU  - Giovannetti, Erin R
AU  - Rebala, Sri
AU  - Sharma, Neha
AU  - Smith, Kelly M
AU  - Walker, Kathryn A
TI  - SHARING Choices: Lessons Learned from a Primary-Care Focused Advance Care Planning Intervention
SN  - 0885-3924
PY  - 2023///
KW  - *Advance Care Planning
KW  - *Alzheimer Disease
KW  - Aged
KW  - Communication
KW  - Humans
KW  - Medicare
KW  - Research Design
KW  - United States
KW  - Automated
KW  - MedStar Health Research Instite
KW  - MedStar Institute for Quality and Safety
KW  - Palliative Care
KW  - AVP, Palliative Care
KW  - Clinical Care Transformation
KW  - MedStar Health
KW  - MedStar Health Performance Improvement
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
N2  - 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)
UR  - https://dx.doi.org/10.1016/j.jpainsymman.2023.04.014
ER  -