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Improving advance care planning in primary care
Descriptive
TitleInfo
Title
Improving advance care planning in primary care
Name
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Singh
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Dashmeet
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1991-
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Dashmeet Singh
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author
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Qureshi
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Rubab
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Rubab Qureshi
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Advisory Committee
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chair
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Rutgers University
Role
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degree grantor
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School of Nursing - RBHS
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school
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theses
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2020
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2020-05
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English
Abstract
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Purpose of Project: As the life spans of Americans are increasing so is the number of people who are living longer with multiple chronic comorbid conditions. End of life care can be protracted and very expensive. However, end of life treatment goals, articulated in advance care planning (ACP), can address these concerns. ACP is defined as the voluntary process in which patients discuss and communicate their future treatment and end-of-life preferences with their provider in case they lose their capacity to make decisions or communicate their wishes and preferences in the future. Primary care settings are ideal for the integration of ACP as part of routine care and health maintenance. However, a review of literature has shown that primary care patients do not routinely engage in ACP with their providers. As such, this project aimed to increase the number of ACP conversations that occur in a single primary care office and attempted to reduce provider associated barriers to ACP in the primary care setting.
Methodology: A quality improvement project that measured the effectiveness of an ACP educational module presented to participants in a live setting. Pretest and posttest design was used to compare participant knowledge base and attitudes towards ACP before and after intervention. Data was analyzed using the McNemar test. Frequencies of the number of times the ACP billing code was used were compared in the 4-week period both before and after intervention.
Results: This study resulted in a positive change in provider knowledge base and attitude towards ACP. Providers reported decreased apprehension in beginning ACP conversations with their patients as a result of the intervention. Additionally, the number of times ACP was billed for in the setting went from 0 pre-intervention to 336 in the post-intervention period. Moreover, a permanent integration of an ACP policy at the primary care center was put into effect as a result of the intervention.
Implications for Practice: This study demonstrated the feasibility of integrating ACP in primary care, increasing revenue for primary care settings, improving patient autonomy in end of life healthcare decision-making, and increasing the overall quality of healthcare services rendered.
Methodology: A quality improvement project that measured the effectiveness of an ACP educational module presented to participants in a live setting. Pretest and posttest design was used to compare participant knowledge base and attitudes towards ACP before and after intervention. Data was analyzed using the McNemar test. Frequencies of the number of times the ACP billing code was used were compared in the 4-week period both before and after intervention.
Results: This study resulted in a positive change in provider knowledge base and attitude towards ACP. Providers reported decreased apprehension in beginning ACP conversations with their patients as a result of the intervention. Additionally, the number of times ACP was billed for in the setting went from 0 pre-intervention to 336 in the post-intervention period. Moreover, a permanent integration of an ACP policy at the primary care center was put into effect as a result of the intervention.
Implications for Practice: This study demonstrated the feasibility of integrating ACP in primary care, increasing revenue for primary care settings, improving patient autonomy in end of life healthcare decision-making, and increasing the overall quality of healthcare services rendered.
Subject
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ACP
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Family Nurse Practitioner
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Rutgers University Electronic Theses and Dissertations
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ETD_10722
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1 online resource (79 pages) : illustrations
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DNP
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Includes bibliographical references
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School of Nursing (RBHS) DNP Projects
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rucore10004500001
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doi:10.7282/t3-j11s-0b39
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ETD doctoral
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Rights
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The author owns the copyright to this work.
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Name
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Singh
GivenName
Dashmeet
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Permission or license
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2020-04-10 12:28:57
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Dashmeet Singh
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Rutgers University. School of Nursing - RBHS
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Author Agreement License
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I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
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2020-05-31
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2022-05-31
Detail
Access to this PDF has been restricted at the author's request. It will be publicly available after May 31st, 2022.
Copyright
Status
Copyright protected
Availability
Status
Open
Reason
Permission or license
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