背景:严重疾病对话(SIC),特别是对于患有认知障碍(PLCI)的人,在初级保健中不一致地发生。务实,需要可扩展的策略来推广PLCI的SIC。
方法:务实,在2021年7月1日至2022年5月30日之间进行的前瞻性单臂试点研究,涉及北卡罗来纳州的七个初级保健实践。
方法:社区居住的65岁及以上已知或可能患有轻度认知障碍或痴呆(具有决策能力)的患者及其护理伙伴(如果有)。
方法:通过视频或电话进行SIC远程医疗干预(TeleVoice),以协助PLCI讨论其当前目标,值,和未来的医疗偏好,同时促进EHR内的文档记录。
结果:主要可行性结果包括覆盖/注册,干预完成,以及诊所和提供者级别的采用率。主要有效性结果包括EHR中的SIC文档和质量以及提前护理计划计费(ACP)代码的使用。
结果:在接受的163个合格的PLCI中,107名(66%)登记(平均年龄83.7岁,68.2%为女性,16.8%黑色,22%的人生活在社会经济劣势较高的地理区域)和81(76%)完成了SIC远程保健干预;45名护理伙伴同意参加(平均年龄71.5岁,80%女性)。诊所的采用率为50%,而这些诊所中有75%的提供者参加了。在完成干预的PLCI中,ACP账单代码的SIC文档和使用率分别为100%和96%,分别,96%(n=78)有高质量的SIC文件。在电话访问和视频访问之间没有观察到显着差异。
结论:这些发现提供了初步证据,支持通过远程医疗进行SIC的可行性,以专门满足社区居住的PLCI的需求。需要进一步调查干预措施的可持续性及其对患者和护理人员结果的长期影响。
BACKGROUND: serious illness conversations (SIC), particularly for persons living with cognitive impairment (PLCI), inconsistently happen in primary care.
Pragmatic, scalable strategies are needed to promote SIC for PLCI.
METHODS: Pragmatic, prospective single-arm pilot study that occurred between July 1, 2021 and May 30, 2022 across seven primary care practices in North Carolina.
METHODS: Community-dwelling patients aged 65 and older with known or probable mild cognitive impairment or dementia (with decision-making capacity) and their care partners (if available).
METHODS: SIC telehealth intervention (TeleVoice) via video or telephone to assist PLCI in discussing their current goals, values, and future medical preferences, while facilitating documentation within the EHR.
RESULTS: Main feasibility outcomes included reach/enrollment, intervention completion, and adoption rates at the clinic and provider level. Primary effectiveness outcomes included SIC documentation and quality within the EHR and usage of advance care planning billing (ACP) codes.
RESULTS: Of the 163 eligible PLCI approached, 107 (66%) enrolled (mean age 83.7 years, 68.2% female, 16.8% Black, 22% living in a geographic area of high socioeconomic disadvantage) and 81 (76%) completed the SIC telehealth intervention; 45 care partners agreed to participate (mean age 71.5 years, 80% female). Adoption at clinic level was 50%, while 75% of providers within these clinics participated. Among PLCI that completed the intervention, SIC documentation and usage of ACP billing codes was 100% and 96%, respectively, with 96% (n = 78) having high-quality SIC documentation. No significant differences were observed between telephone and video visits.
CONCLUSIONS: These findings provide preliminary evidence to support the feasibility of conducting SICs through telehealth to specifically meet the needs of community-dwelling PLCI. Further investigation of the sustainability of the intervention and its long-term impact on patient and caregiver outcomes is needed.