Outcomes of a Three-Year Quality Improvement Study to Improve Advance Care Planning in Patients with Decompensated Cirrhosis.,The American Journal of Gastroenterology

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Outcomes of a Three-Year Quality Improvement Study to Improve Advance Care Planning in Patients with Decompensated Cirrhosis.
The American Journal of Gastroenterology ( IF 9.8 ) Pub Date : 2023-11-07 , DOI: 10.14309/ajg.0000000000002570
Arpan Patel _{1,

2} , Chip A Bowman ₃ , Nicole Prause ₁ , Saikiran M Kilaru ₄ , Andrew Nguyen ₅ , Nina Kogekar ₆ , Cynthia Cohen ₇ , Lindsay Channen ₈ , Alyson Harty ₉ , Ponni Perumalswami ₁₀ , Douglas Dietrich ₉ , Thomas Schiano ₁₁ , Christopher Woodrell _{12,

13} , Ritu Agarwal ₉

Affiliation

Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Department of Gastroenterology, Hepatology, and Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Division of Digestive and Liver Diseases, Department of Medicine, Columbia University New York Presbyterian Hospital, New York, New York, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
Department of Gastroenterology and Hepatology, Kaiser Permanente Washington, Seattle, Washington, USA.
Division of Gastroenterology, Montefiore Medical Center, Bronx, New York, USA.
Division of Gastroenterology and Hepatology, Westchester Medical Center.
Warren Alpert Medical School of Brown University in Providence, Providence, Rhode Island, USA.
Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
Recanati Miller Transplant Institute, Mount Sinai Hospital, New York, New York, USA.
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.

OBJECTIVES To report outcomes of a 3-year quality improvement (QI) pilot study to improve advance directive (AD) completion. METHODS The pilot consisted of champions, education, electronic health record templates, and workflow changes. We assessed changes, predictors, and effects of AD completion. RESULTS The pilot led to greater (8.3% to 36%) and earlier AD completion, particularly among those divorced, with alcohol-associated liver disease, and higher MELD-Na. Decedents whose AD's specified non-aggressive goals experienced lower hospital lengths of stay. CONCLUSIONS ACP initiatives are feasible and may reduce healthcare utilization among decedents requesting less aggressive care.

中文翻译：

旨在改善失代偿性肝硬化患者预先护理计划的三年质量改进研究的结果。

目标报告为期 3 年的质量改进 (QI) 试点研究的结果，以提高预设医疗指示 (AD) 的完成率。方法该试点项目包括支持者、教育、电子健康记录模板和工作流程变更。我们评估了 AD 完成的变化、预测因素和影响。结果该试点项目导致更多（8.3% 至 36%）和更早的 AD 完成，特别是对于那些离婚、患有酒精相关性肝病和更高 MELD-Na 的人。AD 指定的非侵略性目标的死者的住院时间较短。结论 ACP 举措是可行的，并且可能会减少要求不太积极护理的死者的医疗保健利用率。

更新日期：2023-11-07

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