부산대학교 도서관

1. Participants will appreciate the benefit of training and deploying clinical (non-specialist palliative care) team members of all disciplines in facilitating earlier goals of care conversations in a hospital setting. 2. Using PACT as an example, participants will be able to describe multiple factors that are necessary for a quality improvement project to influence behavior change and lead to constructive outcomes in a hospital setting. The PACT project promoted broad (non-palliative care) clinical team involvement in facilitating Goals of Care conversations for hospitalized patients. It was associated with both goal-aligned care and decreased resource utilization at the end of life. Earlier Goals of Care Conversations (GoCC) may be facilitated by training multiple members of the clinical team to initiate GoCc with hospitalized patients. To evaluate the effect of The Preference-Aligned Communication and Treatment (PACT) Project on promoting GoCC, goal-concordant care, and resource utilization at the end-of-life (EOL). Hospitals enrolled in a three-year quality improvement initiative which included skills training for clinical champions and support for process improvement. Medicare patients who screened positive on a trigger tool, had a goals of care conversation, and died within the study period were included in the utilization analysis. The primary outcome was the percentage of patients with EOL care discordant with documented wishes, assessed by comparing documented GOCc to Medicare claims. Secondary outcomes were EOL resource utilization metrics, assessed by analyzing Medicare claims data for intervention patients compared to matched controls from non-PACT units in each hospital. A total of 153 PACT champions across 18 units in 9 hospitals were trained, with the majority being nurses, social workers, and chaplains. A total of 51,087 patients were admitted to PACT units. Of the total, 15.7% screened positive and 68.8% of eligible patients had at least one GoCC. Of that group, 1347 patients were included in the outcomes analysis. Rates of discordance between wishes and care were generally low. Compared to the control group, patients in the intervention group in the last week of life had lower costs (-$976.05, p=0.010), fewer ICU admissions (OR 0.9, p=0.005), and were less likely to undergo resuscitation. They were also more likely to enroll in hospice (OR 1.81, p< 0.001). A multi-site quality improvement intervention for seriously ill hospitalized patients resulted in broad clinical team involvement and was associated with both goal-aligned care and decreased resource utilization at the EOL. Quality Improvement / Shared Decision Making / Advance Care Planning [ABSTRACT FROM AUTHOR]