Triggering goals of care conversations in heart failure patients.

IF 1.2 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES Journal of the American Association of Nurse Practitioners Pub Date : 2022-10-01 DOI:10.1097/JXX.0000000000000774
Yichun M Fang, Shelly S de Peralta
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Abstract

Background: Goals of care conversations (GoCCs) are essential discussions, for those with chronic diseases, to identify a health care surrogate, initiate and review advance directives, and refer for palliative care. Prognosis with pulmonary hypertension (PH) related to heart failure (HF) remains challenging due to variation in trajectory of disease progression. The Gagne Combined Comorbidity score, an electronic prognostication score (E-Gagne), can be used to identify patients with high (>10%) 1-year mortality.

Local problem: Implementation of E-Gagne tool to identify HF patients with high 1-year mortality risk and trigger GoCCs.

Methods: Plan-Do-Study-Act cycles were used throughout nine-week pre- and postintervention in an outpatient setting. Descriptive statistics and Chi-square analysis were used to compare GoCCs pre and post intervention.

Intervention: Using the E-Gagne tool, PH patients with high mortality risk were identified, within 1 week of their scheduled appointments. GoCCs education was provided to all stakeholders. Medical records were reviewed for four aspects of GoCCs: presence and review of advanced directive, documented health care surrogates, and referral for palliative care.

Results: Documentation of GoCCs was greater postintervention compared with preintervention (0%, n = 0/47 and 88%, n = 35/40 respectively, p < .001). Documentation of each of the four aspects of GoCCs was variable with the greatest improvement in documentation of health care surrogate and review of advance directives. There were no referrals for palliative care (0%, n = 0/47 and 0%, n = 0/40).

Conclusion: Implementation of the E-Gagne tool, an electronic prognostication tool, identified high-risk PH HF patients and was effective in increasing documentation of GoCCs.

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心衰患者护理对话的触发目标。
背景:护理对话的目标(GoCCs)是必不可少的讨论,为慢性病患者,以确定卫生保健代理,启动和审查预先指示,并转介姑息治疗。由于疾病进展轨迹的变化,与心力衰竭(HF)相关的肺动脉高压(PH)的预后仍然具有挑战性。Gagne合并合并症评分是一种电子预后评分(E-Gagne),可用于识别1年死亡率高(>10%)的患者。局部问题:使用E-Gagne工具识别1年死亡风险高的心衰患者并触发gocc。方法:计划-做-研究-行动周期在门诊治疗前和干预后的9周内使用。采用描述性统计和卡方分析比较干预前后的gocc。干预措施:使用E-Gagne工具,在预定预约的1周内确定具有高死亡率风险的PH患者。向所有利益攸关方提供教育。对gocc的四个方面的医疗记录进行了审查:高级指示的存在和审查,记录的医疗保健代理,以及转诊姑息治疗。结果:与干预前相比,干预后gocc的记录率更高(分别为0%,n = 0/47和88%,n = 35/40, p < 0.001)。gocc四个方面的每一个方面的文件都是可变的,其中最大的改进是医疗代理的文件和预先指示的审查。没有转介姑息治疗(0%,n = 0/47和0%,n = 0/40)。结论:电子预测工具E-Gagne的实施,识别了高风险的PH HF患者,并有效地增加了gocc的记录。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of the American Association of Nurse Practitioners
Journal of the American Association of Nurse Practitioners HEALTH CARE SCIENCES & SERVICES-NURSING
CiteScore
2.00
自引率
16.70%
发文量
172
期刊介绍: The Journal of the American Association of Nurse Practitioners (JAANP) is a monthly peer-reviewed professional journal that serves as the official publication of the American Association of Nurse Practitioners. Published since 1989, the JAANP provides a strong clinical focus with articles related to primary, secondary, and tertiary care, nurse practitioner education, health policy, ethics and ethical issues, and health care delivery. The journal publishes original research, integrative/comprehensive reviews, case studies, a variety of topics in clinical practice, and theory-based articles related to patient and professional education. Although the majority of nurse practitioners function in primary care, there is an increasing focus on the provision of care across all types of systems from acute to long-term care settings.
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