Feasibility of Group Visits for Advance Care Planning Among Patients with Heart Failure and Their Caregivers

Bandini, Julia; Kogan, Alexis Coulourides; Olsen, Bonnie; Phillips, Jessica; Sudore, Rebecca L.; Bekelman, David B.; Ahluwalia, Sangeeta C.

doi:10.3122/jabfm.2021.01.200184

Cited by 7 publications

(6 citation statements)

References 30 publications

(39 reference statements)

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“…Group medical visits are also an efficient way to reach several patients at once and have been shown to be highly effective. 70 – 72 …”

Section: Resultsmentioning

confidence: 99%

What Clinicians and Researchers Should Know About the Evolving Field of Advance Care Planning: a Narrative Review

McMahan,

Hickman,

Sudore

2024

J GEN INTERN MED

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Advance care planning (ACP) has been recognized as crucial by patients, families, and clinicians; however, different definitions and measurements have led to inconsistencies in practice and mixed evidence in the literature. This narrative review explores ACP’s evolution, innovations, and outcomes using thematic analysis to synthesize data from randomized controlled trials, reviews, and editorials. Key findings include (1) ACP has evolved over the past several decades from a sole focus on code status and advance directive (AD) forms to a continuum of care planning over the life course focused on tailored preparation for patients and surrogate decision-makers and (2) ACP measurement has evolved from traditional outcome metrics, such as AD completion, to a comprehensive outcomes framework that includes behavior change theory, systems, implementation science, and a focus on surrogate outcomes. Since the recent development of an ACP consensus definition and outcomes framework, high-quality trials have reported mainly positive outcomes for interventions, especially for surrogates, which aligns with the patient desire to relieve decision-making burden for loved ones. Additionally, measurement of “clinically meaningful” ACP information, including documented goals of care discussions, is increasingly being integrated into electronic health records (EHR), and emerging, real-time assessments and natural language processing are enhancing ACP evaluation. To make things easier for patients, families, and care teams, clinicians and researchers can use and disseminate these evolved definitions; provide patients validated, easy-to-use tools that prime patients for conversations and decrease health disparities; use easy-to-access clinician training and simple scripts for interdisciplinary team members; and document patients’ values and preferences in the medical record to capture clinically meaningful ACP so this information is available at the point of care. Future efforts should focus on efficient implementation, expanded reimbursement options, and seamless integration of EHR documentation to ensure ACP’s continued evolution to better serve patients and their care partners.

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“…Group medical visits are also an efficient way to reach several patients at once and have been shown to be highly effective. 70 – 72 …”

Section: Resultsmentioning

confidence: 99%

What Clinicians and Researchers Should Know About the Evolving Field of Advance Care Planning: a Narrative Review

McMahan,

Hickman,

Sudore

2024

J GEN INTERN MED

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“…As part of a larger study of ACP group visits for patients with heart failure and their caregivers conducted at a large academic medical center in a major metropolitan area, we evaluated the preliminary impact of the group visits on ACP‐relevant outcomes. Findings pertaining to the feasibility and acceptability of the group visit structure and curriculum are reported separately 21 …”

Section: Methodsmentioning

confidence: 99%

“…Participants, including patients and their caregivers, who indicated interest were administered a short cognitive screener by phone 25 and, if appropriate, were scheduled for a group visit. Full recruitment procedures are described in detail elsewhere 21 . All study procedures were approved by the institutional review boards of the clinical site and the grantee institution.…”

Section: Methodsmentioning

confidence: 99%

“…Full recruitment procedures are described in detail elsewhere. 21 All study procedures were approved by the institutional review boards of the clinical site and the grantee institution.…”

Section: Recruitment and Eligibilitymentioning

confidence: 99%

“…Findings pertaining to the feasibility and acceptability of the group visit structure and curriculum are reported separately. 21…”

Section: Overviewmentioning

confidence: 99%

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Impact of group visits for older patients with heart failure on advance care planning outcomes: Preliminary data

Ahluwalia

Bandini

Kogan

et al. 2021

J American Geriatrics Society

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Objective: Advance care planning (ACP) is critically important for heart failure patients, yet important challenges exist. Group visits can be a helpful way to engage patients and caregivers in identifying values and preferences for future care in a resource-efficient way. We sought to evaluate the impact of group visits for ACP among older adults with heart failure and their caregivers on ACP-related outcomes.Methods: We conducted a mixed-methods pilot study evaluating the impact of an ACP group visit for older adults with heart failure and their caregivers on ACP-related outcomes including readiness and self-efficacy. The evidencebased PREPARE for Your Care video-based intervention was used to guide the group visits. Twenty patients and 10 caregivers attended one of the five 90-min group visits led by a trained facilitator. Group visit participants completed pre-, post-, and 1-month follow-up surveys using validated 5-point ACP readiness and self-efficacy scales. Qualitative feedback obtained within 3 days of a group visit was analyzed using a directed content analysis. Results: Patient participants had a median age of 78 years. Approximately half were female while caregiver participants were mostly female. Participants were predominantly white. Patient readiness scores improved significantly pre-topost (+0.53; p = 0.002) but was not sustained at 1-month follow-up. Patient and caregiver self-efficacy showed some improvement pre-to-post but was also not sustained at follow-up. Interviews revealed positive impacts of group visits across the three themes: encouraging reviewing or revisiting prior ACP The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the National Institutes of Health, the Department of Veterans Affairs, or the United States government.

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Advance Care Planning (ACP) in Medicare Beneficiaries with Heart Failure

Bose Brill,

Riley,

Prater

et al. 2024

J GEN INTERN MED

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Background Heart failure is a leading cause of death in the USA, contributing to high expenditures near the end of life. Evidence remains lacking on whether billed advance care planning changes patterns of end-of-life healthcare utilization among patients with heart failure. Large-scale claims evaluation assessing billed advance care planning and end-of-life hospitalizations among patients with heart failure can fill evidence gaps to inform health policy and clinical practice. Objective Assess the association between billed advance care planning delivered and Medicare beneficiaries with heart failure upon the type and quantity of healthcare utilization in the last 30 days of life. Design This retrospective cross-sectional cohort study used Medicare fee-for-service claims from 2016 to 2020. Participants A total of 48,466 deceased patients diagnosed with heart failure on Medicare. Main Measures Billed advance care planning services between the last 12 months and last 30 days of life will serve as the exposure. The outcomes are end-of-life healthcare utilization and total expenditure in inpatient, outpatient, hospice, skilled nursing facility, and home healthcare services. Key Results In the final cohort of 48,466 patients (median [IQR] age, 83 [76–89] years; 24,838 [51.2%] women; median [IQR] Charlson Comorbidity Index score, 4 [2–5]), 4406 patients had an advance care planning encounter. Total end-of-life expenditure among patients with billed advance care planning encounters was 19% lower (95% CI, 0.77–0.84) compared to patients without. Patients with billed advance care planning encounters had 2.65 times higher odds (95% CI, 2.47–2.83) of end-of-life outpatient utilization with a 33% higher expected total outpatient expenditure (95% CI, 1.24–1.42) compared with patients without a billed advance care planning encounter. Conclusions Billed advance care planning delivery to individuals with heart failure occurs infrequently. Prioritizing billed advance care planning delivery to these individuals may reduce total end-of-life expenditures and end-of-life inpatient expenditures through promoting use of outpatient end-of-life services, including home healthcare and hospice.

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Feasibility of Group Visits for Advance Care Planning Among Patients with Heart Failure and Their Caregivers

Cited by 7 publications

References 30 publications

What Clinicians and Researchers Should Know About the Evolving Field of Advance Care Planning: a Narrative Review

What Clinicians and Researchers Should Know About the Evolving Field of Advance Care Planning: a Narrative Review

Impact of group visits for older patients with heart failure on advance care planning outcomes: Preliminary data

Advance Care Planning (ACP) in Medicare Beneficiaries with Heart Failure

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