A Systematic Intervention To Improve Serious Illness Communication In Primary Care

• Published in: Health Affairs Vol. 36; no. 7; pp. 1258 - 1264
• Main Authors: Lakin, Joshua R., Koritsanszky, Luca A., Cunningham, Rebecca, Maloney, Francine L., Neal, Brandon J., Paladino, Joanna, Palmor, Marissa C., Vogeli, Christine, Ferris, Timothy G., Block, Susan D., Gawande, Atul A., Bernacki, Rachelle E.
• Format: Journal Article
• Language: English
• Published: United States The People to People Health Foundation, Inc., Project HOPE 01.07.2017
• Subjects: Accountability; Accountable care organizations; Advance Care Planning; Advance directives; Best practice; Boston; Clinics; Communication; Complex patients; Decision Making; Electronic health records; End of life; End of life decisions; Family physicians; Female; Females; Health care; Health care management; High risk; Hospitals; Humans; Illnesses; Integrated delivery systems; Intervention; Male; Medical records; Medicine; Mortality; Nephrology; Objectives; Oncology; Palliative care; Patients; Physician-Patient Relations; Physicians; Population; Primary care; Primary Health Care; Quality of life; Risk management; Social workers; Terminal Care; Training; Values; Verbal communication; Women; Womens health; United States > US; Massachusetts; Advance Care Planning; Quality Of Care; Palliative Care; Primary Care
• ISSN: 0278-2715; 2694-233X; 1544-5208; 2694-233X
• DOI: 10.1377/hlthaff.2017.0219

Improving communication about goals and values for patients with advancing serious illness nearing the end of life is a key opportunity to improve the value of care. The Serious Illness Care Program, implemented at primary care clinics affiliated with Brigham and Women's Hospital in Boston, Massachusetts, is a multicomponent intervention designed to support best practices in communication by clinicians to increase conversations with patients with serious illness about their goals and values. We conducted a study of the program in fourteen primary care clinics participating in a high-risk care management program based in an accountable care organization. Patients in the clinics with the program implemented were more likely than those in comparison clinics to have serious illness conversations-including discussion of values and goals-documented in patients' medical records. Clinicians who participated also reported high satisfaction with training they received as part of the program, which they regarded as effective. This work suggests that the Serious Illness Care Program promotes more and better conversations among selected primary care patients, and it highlights the need for further research.