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Improving outpatient advance care planning for adults with congenital or pediatric heart disease followed in a pediatric heart failure and transplant clinic.
Congenit Heart Dis. 2018 May; 13(3):362-368.CH

Abstract

OBJECTIVE

To improve outpatient advanced care planning (ACP) for adults with congenital/pediatric heart disease followed in a pediatric heart failure (HF) and transplant clinic through quality improvement (QI) methodology.

DESIGN

A one-year QI project was completed. We conducted quarterly chart reviews and incorporated feedback from the providers to direct subsequent interventions.

PATIENTS AND SETTING

Patients ≥18 years of age seen in the HF and Transplant Clinic for follow-up visit were included in analysis.

INTERVENTIONS

Interventions focused on five main areas: identifying and training providers to have ACP discussions, standardizing the ACP discussion, standardizing ACP and advance directive (AD) documentation in the electronic medical record, preparing providers to have ACP conversations, and preparing patients to engage in ACP and AD completion.

OUTCOME MEASURES

The outcome measure was percent of adults seen in the HF and Transplant Clinic per month with documented AD (goal 50%). The process measure was percent of adults seen in the HF and Transplant Clinic per month with a documented ACP discussion (goal 100%).

RESULTS

At baseline, no patients had a documented ACP discussion or AD. Fifty-eight adults (mean age 20.4 ± 2.1 years) were seen from March 2016 to February 2017 for a total of 130 visits. In the final month of our study, 75% of adult encounters had a documented ACP discussion and 42% had a documented AD.

CONCLUSIONS

The percentage of documented ADs in adults seen in the HF and Transplant Clinic at a quaternary children's hospital improved through a QI initiative. Over 50% of patients who were engaged in an ACP discussion completed an AD, suggesting this population is receptive to ACP and AD completion.

Authors+Show Affiliations

Texas Children's Hospital, Lillie Frank Abercrombie Section of Pediatric Cardiology, Houston, Texas, USA. Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.Texas Children's Hospital, Lillie Frank Abercrombie Section of Pediatric Cardiology, Houston, Texas, USA. Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. Section of Academic General Pediatrics, Texas Children's Hospital, Houston, Texas, USA. Texas Children's Hospital, Section of Palliative Care, Houston, Texas, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29457357

Citation

Edwards, Lindsay A., et al. "Improving Outpatient Advance Care Planning for Adults With Congenital or Pediatric Heart Disease Followed in a Pediatric Heart Failure and Transplant Clinic." Congenital Heart Disease, vol. 13, no. 3, 2018, pp. 362-368.
Edwards LA, Bui C, Cabrera AG, et al. Improving outpatient advance care planning for adults with congenital or pediatric heart disease followed in a pediatric heart failure and transplant clinic. Congenit Heart Dis. 2018;13(3):362-368.
Edwards, L. A., Bui, C., Cabrera, A. G., & Jarrell, J. A. (2018). Improving outpatient advance care planning for adults with congenital or pediatric heart disease followed in a pediatric heart failure and transplant clinic. Congenital Heart Disease, 13(3), 362-368. https://doi.org/10.1111/chd.12579
Edwards LA, et al. Improving Outpatient Advance Care Planning for Adults With Congenital or Pediatric Heart Disease Followed in a Pediatric Heart Failure and Transplant Clinic. Congenit Heart Dis. 2018;13(3):362-368. PubMed PMID: 29457357.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improving outpatient advance care planning for adults with congenital or pediatric heart disease followed in a pediatric heart failure and transplant clinic. AU - Edwards,Lindsay A, AU - Bui,Christine, AU - Cabrera,Antonio G, AU - Jarrell,Jill Ann, Y1 - 2018/02/18/ PY - 2017/10/11/received PY - 2017/12/26/accepted PY - 2018/2/20/pubmed PY - 2018/7/17/medline PY - 2018/2/20/entrez KW - advance care planning KW - advance directive KW - congenital heart disease KW - heart failure KW - heart transplantation KW - quality improvement SP - 362 EP - 368 JF - Congenital heart disease JO - Congenit Heart Dis VL - 13 IS - 3 N2 - OBJECTIVE: To improve outpatient advanced care planning (ACP) for adults with congenital/pediatric heart disease followed in a pediatric heart failure (HF) and transplant clinic through quality improvement (QI) methodology. DESIGN: A one-year QI project was completed. We conducted quarterly chart reviews and incorporated feedback from the providers to direct subsequent interventions. PATIENTS AND SETTING: Patients ≥18 years of age seen in the HF and Transplant Clinic for follow-up visit were included in analysis. INTERVENTIONS: Interventions focused on five main areas: identifying and training providers to have ACP discussions, standardizing the ACP discussion, standardizing ACP and advance directive (AD) documentation in the electronic medical record, preparing providers to have ACP conversations, and preparing patients to engage in ACP and AD completion. OUTCOME MEASURES: The outcome measure was percent of adults seen in the HF and Transplant Clinic per month with documented AD (goal 50%). The process measure was percent of adults seen in the HF and Transplant Clinic per month with a documented ACP discussion (goal 100%). RESULTS: At baseline, no patients had a documented ACP discussion or AD. Fifty-eight adults (mean age 20.4 ± 2.1 years) were seen from March 2016 to February 2017 for a total of 130 visits. In the final month of our study, 75% of adult encounters had a documented ACP discussion and 42% had a documented AD. CONCLUSIONS: The percentage of documented ADs in adults seen in the HF and Transplant Clinic at a quaternary children's hospital improved through a QI initiative. Over 50% of patients who were engaged in an ACP discussion completed an AD, suggesting this population is receptive to ACP and AD completion. SN - 1747-0803 UR - https://www.unboundmedicine.com/medline/citation/29457357/Improving_outpatient_advance_care_planning_for_adults_with_congenital_or_pediatric_heart_disease_followed_in_a_pediatric_heart_failure_and_transplant_clinic_ L2 - https://doi.org/10.1111/chd.12579 DB - PRIME DP - Unbound Medicine ER -