Outcomes of a 3-Year Quality Improvement Study to Improve Advance Care Planning in Patients With Decompensated Cirrhosis

Author:

Patel Arpan12,Bowman Chip A.3ORCID,Prause Nicole1,Kilaru Saikiran M.4ORCID,Nguyen Andrew5,Kogekar Nina6ORCID,Cohen Cynthia7ORCID,Channen Lindsay8,Harty Alyson9ORCID,Perumalswami Ponni10ORCID,Dietrich Douglas9,Schiano Thomas11,Woodrell Christopher1213,Agarwal Ritu9

Affiliation:

1. Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA;

2. Department of Gastroenterology, Hepatology, and Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA;

3. Division of Digestive and Liver Diseases, Department of Medicine, Columbia University New York Presbyterian Hospital, New York, New York, USA;

4. Division of Gastroenterology and Hepatology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA;

5. Department of Gastroenterology and Hepatology, Kaiser Permanente Washington, Seattle, Washington, USA;

6. Division of Gastroenterology, Montefiore Medical Center, Bronx, New York, USA;

7. Division of Gastroenterology and Hepatology, Westchester Medical Center;

8. Warren Alpert Medical School of Brown University in Providence, Providence, Rhode Island, USA;

9. Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA;

10. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA;

11. Recanati Miller Transplant Institute, Mount Sinai Hospital, New York, New York, USA;

12. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA;

13. Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.

Abstract

Advance care planning in decompensated cirrhosis is recommended but rarely performed. INTRODUCTION: To report outcomes of a 3-year quality improvement pilot study to improve advance directive (AD) completion. METHODS: The pilot consisted of champions, education, electronic health record templates, and workflow changes. We assessed changes, predictors, and effects of AD completion. RESULTS: The pilot led to greater (8.3%–36%) and earlier AD completion, particularly among those divorced, with alcohol-associated liver disease, and with higher Model of End-Stage Liver Disease–Sodium score. Decedents whose AD specified nonaggressive goals experienced lower hospital lengths of stay. DISCUSSION: Advance care planning initiatives are feasible and may reduce health care utilization among decedents requesting less aggressive care.

Funder

American Association for the Study of Liver Diseases

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Gastroenterology,Hepatology

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