Promoting serious illness conversations in primary care through telehealth among persons living with cognitive impairment

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-07-23 DOI:10.1111/jgs.19100

Jennifer L. Gabbard MD, Gretchen A. Brenes PhD, Kathryn E. Callahan MD, MS, Ajay Dharod MD, Richa Bundy MPH, Kristie L. Foley PhD, MS, Adam Moses MHA, Jeff D. Williamson MD, MHS, Nicholas M. Pajewski PhD

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引用次数: 0

Abstract

Background

serious illness conversations (SIC), particularly for persons living with cognitive impairment (PLCI), inconsistently happen in primary care. Pragmatic, scalable strategies are needed to promote SIC for PLCI.

Design

Pragmatic, prospective single-arm pilot study that occurred between July 1, 2021 and May 30, 2022 across seven primary care practices in North Carolina.

Participants

Community-dwelling patients aged 65 and older with known or probable mild cognitive impairment or dementia (with decision-making capacity) and their care partners (if available).

Intervention

SIC telehealth intervention (TeleVoice) via video or telephone to assist PLCI in discussing their current goals, values, and future medical preferences, while facilitating documentation within the EHR.

Main Outcomes

Main feasibility outcomes included reach/enrollment, intervention completion, and adoption rates at the clinic and provider level. Primary effectiveness outcomes included SIC documentation and quality within the EHR and usage of advance care planning billing (ACP) codes.

Results

Of the 163 eligible PLCI approached, 107 (66%) enrolled (mean age 83.7 years, 68.2% female, 16.8% Black, 22% living in a geographic area of high socioeconomic disadvantage) and 81 (76%) completed the SIC telehealth intervention; 45 care partners agreed to participate (mean age 71.5 years, 80% female). Adoption at clinic level was 50%, while 75% of providers within these clinics participated. Among PLCI that completed the intervention, SIC documentation and usage of ACP billing codes was 100% and 96%, respectively, with 96% (n = 78) having high-quality SIC documentation. No significant differences were observed between telephone and video visits.

Conclusion

These findings provide preliminary evidence to support the feasibility of conducting SICs through telehealth to specifically meet the needs of community-dwelling PLCI. Further investigation of the sustainability of the intervention and its long-term impact on patient and caregiver outcomes is needed.

查看原文本刊更多论文

通过远程医疗促进认知障碍患者在初级保健中进行重病对话。

背景：重病会话（SIC），尤其是针对认知障碍患者（PLCI）的重病会话，在基层医疗机构的开展并不一致。我们需要务实、可扩展的策略来促进针对认知障碍患者的重病对话：务实、前瞻性的单臂试点研究，于 2021 年 7 月 1 日至 2022 年 5 月 30 日期间在北卡罗来纳州的七个初级保健诊所进行：已知或可能患有轻度认知障碍或痴呆症（有决策能力）的 65 岁及以上社区居民患者及其护理伙伴（如有）：干预措施：通过视频或电话进行 SIC 远程医疗干预（TeleVoice），以协助 PLCI 讨论他们当前的目标、价值观和未来的医疗偏好，同时促进 EHR 中的文档记录：主要可行性结果包括覆盖率/注册率、干预完成率以及诊所和提供者层面的采用率。主要有效性结果包括电子病历中的 SIC 文档和质量，以及预先护理规划计费（ACP）代码的使用情况：在 163 名符合条件的 PLCI 接洽者中，107 人（66%）注册（平均年龄 83.7 岁，68.2% 为女性，16.8% 为黑人，22% 生活在社会经济条件较差的地区），81 人（76%）完成了 SIC 远程医疗干预；45 名护理合作伙伴同意参与（平均年龄 71.5 岁，80% 为女性）。诊所一级的采用率为 50%，而这些诊所内 75% 的医疗服务提供者参与了干预。在完成干预的 PLCI 中，SIC 文档和 ACP 账单代码的使用率分别为 100% 和 96%，其中 96% （n = 78）拥有高质量的 SIC 文档。电话访问和视频访问之间未发现明显差异：这些研究结果提供了初步证据，支持通过远程医疗开展 SIC 的可行性，以专门满足居住在社区的 PLCI 的需求。还需要进一步调查该干预措施的可持续性及其对患者和护理人员结果的长期影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.