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We know advance care planning is very important – but it can be difficult for everyone to talk about a time when they would be unable to decide their own health care. Data shows that both locally and nationally, not enough people prepare for this point. That’s why it’s so critical to make advance care planning more accessible and part of the regular planning we do in the rest of our lives.Several local medical practices – Centennial Medical Group, Columbia Medical Practice and Ascension Medical Group (formerly Seton Medical Group) – have been working to do just that.
Starting in March 2019, the Horizon Foundation sponsored these three organizations to work with the Institute for Healthcare Improvement (IHI) to embed “Conversation Ready” principles into their daily practices and ensure that their patients’ health care wishes can be more comfortably expressed and respected. IHI led a series of webinars, provided one-on-one coaching and conducted site visits at each practice.
The three provider groups deployed a number of strategies in order to boost their engagement with patients about planning their advance directive and documenting their wishes. Centennial focused on a “piggyback/piggy-front” approach, where they leveraged a pharmacist to discuss advance care planning in her pre-visit calling work for patients and as well as medical assistants at the time of care in the office. Columbia Medical Practice – who participated in the initial Speak(easy) Howard collaborative in 2016-2017 – continued to utilize its Medicare Wellness nurses to engage patients in advance care planning during their annual wellness visits as well as train other RNs who provide that service to do the same. Ascension focused on identifying “high-risk” patients and then using point of care interventions with social work and care management at the time of scheduled visits.
Through this work, each organization worked to identify and work with patients “about whom there can be no argument” – in other words, they focused first on patients where it is clear that creating an advance care plan is timely and most needed. Utilizing physicians, nurses, pharmacists and other staff to engage patients during their annual wellness visits enabled the practices to begin to build out their systems to more easily engage all patients about this topic. Over the course of the year working and getting training from IHI, each practice group increased their percentage of patients who either planned to create their advance directive or documented their health care wishes.
The COVID-19 pandemic has brought the importance of advance care planning into a new light. While we can’t predict every situation or every choice we might have to make, having an advance care plan and discussing our health care wishes with our loved ones and our doctors is still the best tool we have to be prepared for a health care emergency – and it will remain so even after the COVID-19 threat is behind us. Making advance care planning the norm in primary care settings is one crucial way to spark these conversations, educate patients and make the process easier and more accessible.
While much more work still needs to be done to bring advance care planning to more Howard County residents, Centennial Medical Group, Columbia Medical Practice and Ascension Medical Group are all leading the way.
