Lessons Learned From a Pilot Project on Telemedicine Advance Care Planning in an Urban Geriatric Primary Care Office

Seecof, Olivia; Allanoff, Molly; Liantonio, John; Parks, Susan

doi:10.1177/10499091211036978

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…The virtual visit confers the added benefit of being able to include additional family members who may not be co‐located. These family members may be able to help incorporate patient values into discussions of treatment options and goals of care and the development of patient‐centered care plans 27 …”

Section: Resultsmentioning

confidence: 99%

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Competencies for video telemedicine with older adult patients

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Schwartz

et al. 2023

J American Geriatrics Society

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Background Telemedicine has recently become a part of mainstream clinical practice. Many curricula have been developed to teach general and specialty‐specific video telemedicine skills; however, a lack of defined best practices for translating comprehensive interprofessional geriatric care to the virtual setting presents a unique challenge to educators and clinicians. This manuscript introduces and describes the development of competencies for video telemedicine with older adults for all health professionals who treat them. Methods A modified Delphi process was used in competency development. In 2019, interprofessional clinicians and educators who had expertise in telemedicine formed a competency development workgroup. The aim was to draft competencies for interprofessional video telemedicine with older adults while not duplicating existing competencies in geriatrics, interprofessional care, or general telemedicine. Draft competencies were circulated among experts in geriatric telemedicine and geriatric education for two rounds of comments. The competencies incorporated comments from 41 clinicians representing 7 professions. Results Twenty‐three competencies were created spanning six domains. A temporal organization by domain was used: (1) Overarching considerations, (2) Pre‐visit preparation, (3) Beginning of the visit, (4) History taking and communication during the visit, (5) Exam during the visit (organized by the 5Ms: Mind, Mobility, Medication, Multicomplexity, and Matters Most), and (6) Post‐visit coordination. Conclusions These newly developed competencies fill a gap left by those developed for specific disciplines or that do not address considerations for older adults. They lay the groundwork for curriculum development and the development of virtual Age‐Friendly care.

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Section: Resultsmentioning

confidence: 99%

“…These family members may be able to help incorporate patient values into discussions of treatment options and goals of care and the development of patient-centered care plans. 27…”

Section: Exam During the Telemedicine Visitmentioning

confidence: 99%

Competencies for video telemedicine with older adult patients

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Schwartz

et al. 2023

J American Geriatrics Society

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“…Understanding how to best use telehealth to inform preferences for care and enhance patient-centered decision making is an active area of research. 30 Several key federal regulatory changes have facilitated the use of telehealth to provide ACP including flexibilities in providing services across state lines, changes to originating site definitions, and reimbursement of ACP services furnished using audio-only technology. 31 While telehealth use increased dramatically, access to these services has not been equitable.…”

Section: Acp Telehealthmentioning

confidence: 99%

Federal Advance Care Planning Policy Primer – Key Aspects, Barriers, and Opportunities

Singh

Jones²,

Grant

et al. 2023

Am J Hosp Palliat Care

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Advance care planning (ACP) is a nuanced process where patients identify their goals and consider their preferences for medical care over time. Recent systematic reviews have shown mixed findings about the association of ACP with the provision of goal-concordant care, completion of advance directives, and health care utilization. Despite a lack of consistent benefit, patients and clinicians value ACP and policy makers at the state and federal level have been moving ACP policies forward. All fifty states have policies regarding advance directives, and federal policy has had important implications on promoting awareness of ACP and its corresponding legal documents such as advance directives. However, challenges to effectively incentivize and facilitate the delivery of high-quality ACP exist. This paper provides an overview of key federal policy aspects and barriers that affect ACP use including: limitations of Medicare ACP billing codes, disparities in telemedicine access, difficulties with interoperability of advance directives, and underutilization of ACP as a mandatory measure in federal programs. This paper highlights key opportunities to improve federal ACP policy. Because ACP is an essential part of high-quality care and is deeply embedded in state and federal policies, it is imperative that clinicians are knowledgeable about these issues so they may more effectively engage in ACP policy.

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Participation in Advance Care Planning Among Medically At-Risk Rural Veterans: Protocol for a Personalized Engagement Model

Walkner,

Karr,

Murray

et al. 2024

JMIR Res Protoc

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Background Many of the challenges in advanced care planning (ACP) conversations are linked to the waxing and waning progress of serious illnesses. Conversations with patients about future medical care decisions by a surrogate decision maker have historically been left until late in the patient’s disease trajectory. These conversations often happen at a time when the patient is already very ill. The challenge in effective early ACP and serious illness conversations is to create a situation where patients appreciate the link between current and future medical care. Setting the stage to make these conversations more accessible includes using telehealth to have conversations at the patient’s place of choice. The personalization used includes addressing the current medical and social needs of the patient and ensuring that expressed needs are addressed as much as possible. Engaging patients in these conversations allows the documentation of patient preferences in the electronic health record (EHR), providing guidelines for future medical care. Objective The objective of our telehealth serious illness care conversations program was to successfully recruit patients who lacked up-to-date documentation of ACP in their EHR. Once these patients were identified, we engaged in meaningful, structured conversations to address the veterans’ current needs and concerns. We developed a recruitment protocol that increased the uptake of rural veterans’ participation in serious illness care conversations and subsequent EHR documentation. Methods The recruitment protocol outlined herein used administrative data to determine those patients who have not completed or updated formal ACP documentation in the EHR and who are at above-average risk for death in the next 3-5 years. The key features of the telehealth serious illness care conversations recruitment protocol involve tailoring the recruitment approach to address current patient concerns while emphasizing future medical decision-making. Results As of September 2022, 196 veterans had completed this intervention. The recruitment method ensures that the timing of the intervention is patient driven, allowing for veterans to engage in ACP at a time and place convenient for them and their identified support persons. Conclusions The recruitment protocol has been successful in actively involving patients in ACP conversations, leading to an uptick in completed formal documentation of ACP preferences within the EHR for this specific population. This documentation is then available to the medical team to guide future medical care. International Registered Report Identifier (IRRID) RR1-10.2196/55080

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Lessons Learned From a Pilot Project on Telemedicine Advance Care Planning in an Urban Geriatric Primary Care Office

Cited by 4 publications

References 8 publications

Competencies for video telemedicine with older adult patients

Competencies for video telemedicine with older adult patients

Federal Advance Care Planning Policy Primer – Key Aspects, Barriers, and Opportunities

Participation in Advance Care Planning Among Medically At-Risk Rural Veterans: Protocol for a Personalized Engagement Model

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