Automated Identification of Patients with Advanced Illness.

Early identification of advanced illness patients within an inpatient population is essential in order to establish the patient's goals of care. Having goals of care conversations enables hospital patients to dictate a plan for care in concordance with their values and wishes. These conversations allow a patient to maintain some control, rather than be subjected to a default care process that may not be desired and may not provide benefit. In this study the performance of two approaches which identify advanced illness patients within an inpatient population were evaluated: LACE (a rule-based approach that uses L - Length of stay, A- Acuity of Admission, C- Co-morbidities, E- Emergency room visits), and a novel approach: Hospital Impairment Score (HIS). The Hospital impairment score is derived by leveraging both rule-based insights and a novel machine learning algorithm. It was identified that HIS significantly outperformed the LACE score, the current model being used in production at Northwell Health. Furthermore, we describe how the HIS model was piloted at a single hospital, was launched into production, and is being successfully used by clinicians at that hospital.

Goals of care conversation education program: An intervention to help health care professionals break bad news to patients with advanced illness.

The purpose of the study was to measure the effectiveness of communication skills intervention results for healthcare professionals. A multi-site pretest-posttest survey assessing the efficacy of a Goals of Care conversation education program. The program aimed to educate healthcare professionals concerning having Goals of Care conversations with patients and families. This research was implemented in a large healthcare organization in the Northeastern United States. This study found significant differences between pretests and posttests across professions, palliative care specialty, degree types, and years of experience in the participant's self-reported ability and comfort levels in having conversations about Goals of Care with patients and families. Providing education on Goals of Care was effective in improving the knowledge and comfort of health care professionals with conducting advanced illness conversations.

Changing the Care Paradigm for Patients: Advanced Illness Beds Care Model.

BACKGROUND: Over 90 million Americans suffer from advanced illness (AI) and spend their last days of life in critical care units receiving costly, unwanted, aggressive medical care. OBJECTIVE: Evaluate the impact of a specialized care model in medical/surgical units for hospitalized geriatric patients and patients with complex care requirements where designated AI beds align care with patient's wishes/goals, minimize aggressive interventions, and influence efficient resource utilization. DESIGN: US based multi-facility retrospective, longitudinal descriptive study of screened positive AI patients in AI Beds (N = 1,237) from 3 facilities from 2015 to 2017. RESULTS: Patient outcomes included 60% referrals to AI beds from ICU, a decrease of 39-49% in average ICU LOS, a 23% reduction of AI bed patient expirations, 9.0% referrals to hospice, and projected cost savings of $4,361.66/patient, US dollars. CONCLUSION: Allocating AI beds to deliver care to AI patients resulted in a decreased cost of care by reducing overall hospital LOS, mortality, and efficient use of both critical care and hospital resources.

The development and piloting of a goals of care conversation education program for an advanced illness population.

Ten thousand Americans turn 65 daily. With age, individuals are confronted by complex medical modalities which can be difficult to understand and potentially burdensome. Historically, clinicians lacked the education, skill, and comfort level to identify the need for and address the patient's goals of care (GoC). Inter-professional content experts convened to develop a comprehensive program to educate and increase the comfort level of clinicians when having GoC conversations. The goal was to provide structured guidance to increase the practitioners' level of confidence in engaging patients/families in these conversations. A multimodal educational methodology using simulation was chosen as a learning strategy permitting clinicians to practice GoC conversations while receiving immediate feedback. A five hour inter-professional educational program called Goals of Care Conversation Education Program® (GoCCEP™) was developed and piloted. The GoCCEPTM's evaluations demonstrate success giving clinicians necessary tools and a safe practice environment increasing knowledge and confidence to have substantive GoC conversations.

Flying the Unfriendly Skies: A Case Report.

We report the case of an older adult foreign national with severe respiratory failure who was brought via a commercial airline to the United States. Hospitalized and orally intubated in his home country, his son, a US citizen, decided to translocate his father to the United States. He purchased tickets for adjoining seats on a prominent international commercial airline and brought his orally intubated, stretcher-bound father onto the plane without any accompanying medical professionals, security screening, or preapproved transport. Despite this, they traveled to New York and phoned 911 upon landing, allowing him to bypass the standard customs procedures.