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Health Aff (Millwood). 2017 Jul 1;36(7):1258-1264. doi: 10.1377/hlthaff.2017.0219.

A Systematic Intervention To Improve Serious Illness Communication In Primary Care.

Author information

1
Joshua R. Lakin (jlakin@partners.org) is a palliative care physician at the Dana-Farber Cancer Institute and Brigham and Women's Hospital and an associate faculty member at Ariadne Labs, all in Boston, Massachusetts.
2
Luca A. Koritsanszky is a program manager at Ariadne Labs.
3
Rebecca Cunningham is medical director of the Integrated Care Management Program at Brigham and Women's Hospital and an assisant professor of medicine at Harvard Medical School, both in Boston.
4
Francine L. Maloney is a project manager at Ariadne Labs.
5
Brandon J. Neal is a statistical analyst at Ariadne Labs.
6
Joanna Paladino is a palliative care physician at Dana-Farber Cancer Institute and the assistant director of implementation for the Serious Illness Care Program at Ariadne Labs.
7
Marissa C. Palmor is a medical student at Harvard Medical School.
8
Christine Vogeli is an assistant professor of medicine at Massachusetts General Hospital and Harvard Medical School and director of evaluation and research at the Center for Population Health, Partners HealthCare, in Boston.
9
Timothy G. Ferris is senior vice president of population health at Massachusetts General Hospital and Partners Healthcare and an associate professor of medicine at Harvard Medical School.
10
Susan D. Block is director of the Serious Illness Care Program at Ariadne Labs; founding chair of the Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital; and a professor of psychiatry and medicine, Harvard Medical School.
11
Atul A. Gawande is executive director of Ariadne Labs; a surgeon at Brigham and Women's Hospital; and a professor at the Harvard T. H. Chan School of Public Health and Harvard Medical School.
12
Rachelle E. Bernacki is director of quality initiatives for palliative care at the Dana-Farber Cancer Institute and associate director of the Serious Illness Care Program at Ariadne Labs.

Abstract

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.

KEYWORDS:

Advance Care Planning; Palliative Care; Primary Care; Quality Of Care

PMID:
28679813
DOI:
10.1377/hlthaff.2017.0219
[Indexed for MEDLINE]

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