Earlier identification of seriously ill patients: An implementation case series

Joshua R. Lakin, Meghna Desai, Kyle Engelman, Nina O'Connor, Winifred G. Teuteberg, Alison Coackley, Laurel B. Kilpatrick, Atul Gawande, Erik K. Fromme

    Research output: Contribution to journalArticle

    1 Scopus citations

    Abstract

    Objective: To describe the strategies used by a collection of healthcare systems to apply different methods of identifying seriously ill patients for a targeted palliative care intervention to improve communication around goals and values. Methods: We present an implementation case series describing the experiences, challenges and best practices in applying patient selection strategies across multiple healthcare systems implementing the Serious Illness Care Program (SICP). Results: Five sites across the USA and England described their individual experiences implementing patient selection as part of the SICP. They employed a combination of clinician screens (such as the € Surprise Question'), disease-specific criteria, existing registries or algorithms as a starting point. Notably, each describes adaptation and evolution of their patient selection methodology over time, with several sites moving towards using more advanced machine learning-based analytical approaches. Conclusions: Involving clinical and programme staff to choose a simple initial method for patient identification is the ideal starting place for selecting patients for palliative care interventions. However, improving and refining methods over time is important and we need ongoing research into better patient selection methodologies that move beyond mortality prediction and instead focus on identifying seriously ill patients - those with poor quality of life, worsening functional status and medical care that is negatively impacting their families.

    Original languageEnglish (US)
    JournalBMJ Supportive and Palliative Care
    DOIs
    StatePublished - Jan 1 2019

    Keywords

    • advance care planning
    • palliative care
    • patient identification
    • patient selection
    • serious illness communication
    • triggers

    ASJC Scopus subject areas

    • Medicine (miscellaneous)
    • Oncology(nursing)
    • Medical–Surgical

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  • Cite this

    Lakin, J. R., Desai, M., Engelman, K., O'Connor, N., Teuteberg, W. G., Coackley, A., Kilpatrick, L. B., Gawande, A., & Fromme, E. K. (2019). Earlier identification of seriously ill patients: An implementation case series. BMJ Supportive and Palliative Care. https://doi.org/10.1136/bmjspcare-2019-001789