11:20 - 11:40 amSunday, September 18
Plenary Hall
End of life, not end of story: learning from patients to transform a health system's approach to advance care planning
Plenary Hall
End of life, not end of story: learning from patients to transform a health system's approach to advance care planning
Atrius Health
Care for patients at the end of life requires that patient and clinician have a common understanding of disease status and goals of care in order to ensure that dignity and autonomy are maintained. Having... Read more

Description

Care for patients at the end of life requires that patient and clinician have a common understanding of disease status and goals of care in order to ensure that dignity and autonomy are maintained. Having difficult conversations with patients is a critical skill that can be taught but is often left out of medical school curriculum. All too often, doctors neglect end of life decisions with patients and critical patient preferences are not documented in the medical record.

Physicians cite myriad reasons why these conversations do not take place, including discomfort with the topic, fear of taking away hope, time pressures, and a core lack of understanding of the process. During this talk, I will share my personal journey to understanding the role and importance of advance care planning, which began in an exam room sitting with a patient and listening, rather than completing the intended task of a post-discharge checklist. As I learned to listen more than speak, bring up difficult topics, and tease out what was really important, I realized that this was information that needed to be shared and standardized across the organization.

After endorsement from leadership, a team was formed to lead the design of new curricula and new modules for the EHR which has resulted in success for the organization as well as better care for our patients. The resulting program, implemented at Atrius Health, included a multi-disciplinary, multi-year strategy to engage the full health team in both personal (sharing experience) and structural (modifying the EHR to encourage and support end of life discussions) ways.

At the end of the three year pilot, we improved documented advance care planning by more than 270%, with over 80% of primary care teams trained in documentation, goal planning, and difficult conversations. This success has transformed this effort from a pilot to the current standard of care. We continue to seek new avenues to further this important conversation. Our goal, which is very much attainable, is that all of our patients have the opportunity to share preferences regarding treatment at the end of life and that these choices are honored. Death is inevitable; death with dignity and according to one’s personal wishes should be as well.

 

Eliza “Pippa”
Shulman, DO, MPH is the Senior Chief Innovation Engineer at the newly formed
Atrius Health Innovation Center, charged with identifying, testing and
implementing novel care delivery solutions the largest
independent multi-specialty medical group in the Northeast. In addition she is
a practicing primary care physician with a small geriatrics and palliative
medicine consultation service.

 

Prior to being
named to the Innovation Center Pippa was the Chief of Geriatrics and Palliative
Care at Harvard Vanguard Medical Associates; tasked with leading improvement efforts
in home care, extended care facilities, outpatient geriatrics and palliative
care services. As chief and as part of the ACO
geriatric care model workgroup she led numerous initiatives
to redesign care for frail elder patients, including implementation of an
organization wide strategy for improving advance care planning.

 

Dr Shulman is board certified in family medicine, preventive medicine, and
hospice and palliative medicine. She is a graduate of the combined NH-Dartmouth
Family Medicine Residency and the Dartmouth Hitchcock Leadership Preventive
Medicine Residency, which is focused on developing physicians to lead change
and improve systems of care.

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