A Group Visit Initiative Improves Advance Care Planning Documentation among Older Adults in Primary Care

References

1. 1.↵
   Institute of Medicine. Dying in America: improving quality and honoring individual preferences near the end of life. Washington, DC: National Academies Press; 2015.
2. 2.↵
   1. Osborn R,
   2. Moulds D,
   3. Squires D,
   4. Doty MM,
   5. Anderson C

   . International survey of older adults finds shortcomings in access, coordination, and patient-centered care. Health Aff (Millwood) 2014;33:2247–55.

   OpenUrlAbstract/FREE Full Text
3. 3.↵
   1. Griffin S,
   2. Cubanski J,
   3. Neuman T,
   4. Jankiewicz A,
   5. Rousseau D,
   6. Foundation KF

   . Medicare and end-of-life care. JAMA 2016;316:1754.

   OpenUrl
4. 4.↵
   1. McMahan RD,
   2. Knight SJ,
   3. Fried TR,
   4. Sudore RL

   . Advance care planning beyond advance directives: perspectives from patients and surrogates. J Pain Symptom Manage 2013;46:355–65.

   OpenUrlCrossRefPubMed
5. 5.↵
   1. Tierney WM,
   2. Dexter PR,
   3. Gramelspacher GP,
   4. Perkins AJ,
   5. Zhou XH,
   6. Wolinsky FD

   . The effect of discussions about advance directives on patients' satisfaction with primary care. J Gen Intern Med 2001;16:32–40.

   OpenUrlCrossRefPubMedWeb of Science
6. 6.↵
   1. Wright AA,
   2. Zhang B,
   3. Ray A,
   4. et al

   . Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 2008;300:1665–73.

   OpenUrlCrossRefPubMedWeb of Science
7. 7.↵
   1. Silveira MJ,
   2. Kim SY,
   3. Langa KM

   . Advance directives and outcomes of surrogate decision making before death. N Engl J Med 2010;362:1211–8.

   OpenUrlCrossRefPubMedWeb of Science
8. 8.↵
   1. Sudore RL,
   2. Schickedanz AD,
   3. Landefeld CS,
   4. et al

   . Engagement in multiple steps of the advance care planning process: a descriptive study of diverse older adults. J Am Geriatr Soc 2008;56:1006–13.

   OpenUrlCrossRefPubMedWeb of Science
9. 9.↵
   1. Fried TR,
   2. Bullock K,
   3. Iannone L,
   4. O'Leary JR

   . Understanding advance care planning as a process of health behavior change. J Am Geriatr Soc 2009;57:1547–55.

   OpenUrlCrossRefPubMedWeb of Science
10. 10.↵
    1. Ahluwalia SC,
    2. Bekelman DB,
    3. Huynh AK,
    4. Prendergast TJ,
    5. Shreve S,
    6. Lorenz KA

    . Barriers and strategies to an iterative model of advance care planning communication. Am J Hosp Palliat Care 2015;32:817–23.

    OpenUrlCrossRefPubMed
11. 11.↵
    1. Spoelhof GD,
    2. Elliott B

    . Implementing advance directives in office practice. Am Fam Physician 2012;85:461–6.

    OpenUrlPubMed
12. 12.↵
    1. Kim SL,
    2. Tarn DM

    . Effect of primary care involvement on end-of-life care outcomes: a systematic review. J Am Geriatr Soc 2016;64:1968–74.

    OpenUrl
13. 13.↵
    1. Ramsaroop SD,
    2. Reid MC,
    3. Adelman RD

    . Completing an advance directive in the primary care setting: what do we need for success? J Am Geriatr Soc 2007;55:277–83.

    OpenUrlCrossRefPubMedWeb of Science
14. 14.↵
    1. Sudore RL,
    2. Knight SJ,
    3. McMahan RD,
    4. et al

    . A novel website to prepare diverse older adults for decision making and advance care planning: a pilot study. J Pain Symptom Manage 2014;47:674–86.

    OpenUrlCrossRefPubMed
15. 15.↵
    1. Volandes AE,
    2. Mitchell SL,
    3. Gillick MR,
    4. Chang Y,
    5. Paasche-Orlow MK

    . Using video images to improve the accuracy of surrogate decision-making: a randomized controlled trial. J Am Med Dir Assoc 2009;10:575–80.

    OpenUrlCrossRefPubMedWeb of Science
16. 16.↵
    1. Van Scoy LJ,
    2. Green MJ,
    3. Reading JM,
    4. Scott AM,
    5. Chuang CH,
    6. Levi BH

    . Can playing an end-of-life conversation game motivate people to engage in advance care planning? Am J Hosp Palliat Care 2016 Jan 1 [Epub ahead of print]. https://dx.doi.org/10.1177/1049909116656353.
17. 17.↵
    1. Hammes BJ,
    2. Rooney BL,
    3. Gundrum JD

    . A comparative, retrospective, observational study of the prevalence, availability, and specificity of advance care plans in a county that implemented an advance care planning microsystem. J Am Geriatr Soc 2010;58:1249–55.

    OpenUrlCrossRefPubMed
18. 18.↵
    1. Austin CA,
    2. Mohottige D,
    3. Sudore RL,
    4. Smith AK,
    5. Hanson LC

    . Tools to promote shared decision making in serious illness: a systematic review. JAMA Intern Med 2015;175:1213–21.

    OpenUrlCrossRefPubMed
19. 19.↵
    1. Arnett K,
    2. Sudore RL,
    3. Nowels D,
    4. Feng CX,
    5. Levy CR,
    6. Lum HD

    . Advance care planning: understanding clinical routines and experiences of interprofessional team members in diverse health care settings. Am J Hosp Palliat Care 2016 Sept 6 [Epub ahead of print].
20. 20.↵
    1. Lund S,
    2. Richardson A,
    3. May C

    . Barriers to advance care planning at the end of life: an explanatory systematic review of implementation studies. PLoS One 2015;10:e0116629.

    OpenUrlCrossRefPubMed
21. 21.↵
    1. Cherniack EP

    . The use of shared medical appointments in the care of the elderly. J Ambul Care Manage 2014;37:32–7.

    OpenUrlCrossRefPubMed
22. 22.↵
    1. Sikon A,
    2. Bronson DL

    . Shared medical appointments: challenges and opportunities. Ann Intern Med 2010;152:745–6.

    OpenUrlCrossRefPubMedWeb of Science
23. 23.↵
    1. Scott JC,
    2. Conner DA,
    3. Venohr I,
    4. et al

    . Effectiveness of a group outpatient visit model for chronically ill older health maintenance organization members: a 2-year randomized trial of the cooperative health care clinic. J Am Geriatr Soc 2004;52:1463–70.

    OpenUrlCrossRefPubMedWeb of Science
24. 24.↵
    1. Edelman D,
    2. Gierisch JM,
    3. McDuffie JR,
    4. Oddone E,
    5. Williams JW

    . Shared medical appointments for patients with diabetes mellitus: a systematic review. J Gen Intern Med 2015;30:99–106.

    OpenUrlCrossRefPubMed
25. 25.↵
    1. Jaber R,
    2. Braksmajer A,
    3. Trilling JS

    . Group visits: a qualitative review of current research. J Am Board Fam Med 2006;19:276–90.

    OpenUrlAbstract/FREE Full Text
26. 26.↵
    1. Cohen S,
    2. Hartley S,
    3. Mavi J,
    4. Vest B,
    5. Wilson M

    . Veteran experiences related to participation in shared medical appointments. Mil Med 2012;177:1287–92.

    OpenUrlCrossRefPubMed
27. 27.↵
    1. Bronson DL,
    2. Maxwell RA

    . Shared medical appointments: increasing patient access without increasing physician hours. Cleve Clin J Med 2004;71:369–370, 372, 374 passim.

    OpenUrlAbstract/FREE Full Text
28. 28.↵
    1. Eisenstat SA,
    2. Ulman K,
    3. Siegel AL,
    4. Carlson K

    . Diabetes group visits: integrated medical care and behavioral support to improve diabetes care and outcomes from a primary care perspective. Curr Diab Rep 2013;13:177–87.

    OpenUrlCrossRefPubMed
29. 29.↵
    1. Housden L,
    2. Wong ST,
    3. Dawes M

    . Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis. CMAJ 2013;185:E635–44.

    OpenUrlAbstract/FREE Full Text
30. 30.↵
    Shared medical appointments/group visits. Leawood, KS: American Academy of Family Physicians; 2017. Available from: http://www.aafp.org/about/policies/all/shared-medical.html. Accessed April 17, 2015.
31. 31.↵
    1. Lum HD,
    2. Jones J,
    3. Matlock DD,
    4. et al

    . Advance care planning meets group medical visits: the feasibility of promoting conversations. Ann Fam Med 2016;14:125–32.

    OpenUrlAbstract/FREE Full Text
32. 32.↵
    1. Berger-Fiffy J

    . The “nuts and bolts” of implementing shared medical appointments: the Harvard Vanguard Medical Associates experience. J Ambul Care Manage 2012;35:247–56.

    OpenUrlCrossRefPubMed
33. 33.↵
    1. Ogrinc G,
    2. Davies L,
    3. Goodman D,
    4. Batalden P,
    5. Davidoff F,
    6. Stevens D

    . SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 2015;25:986–92.

    OpenUrl
34. 34.↵
    1. Bruffee KA

    . Collaborative learning: higher education, interdependence, and the authority of knowledge. Baltimore: Johns Hopkins University Press; 1993.
35. 35.↵
    The Conversation Project. Starter kits. Available from: http://theconversationproject.org/starter-kit/intro/. Accessed October 13, 2012.
36. 36.↵
    1. Hays RD,
    2. Spritzer KL,
    3. Thompson WW,
    4. Cella D

    . U.S. general population estimate for “excellent” to “poor” self-rated health item. J Gen Intern Med 2015;30:1511–6.

    OpenUrlCrossRefPubMed
37. 37.↵
    1. Hays RD,
    2. Bjorner JB,
    3. Revicki DA,
    4. Spritzer KL,
    5. Cella D

    . Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res 2009;18:873–80.

    OpenUrlCrossRefPubMedWeb of Science
38. 38.↵
    1. Fereday J,
    2. Muir-Cochrane E

    . Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods 2010;5:80–92.

    OpenUrl
39. 39.↵
    1. Crabtree BF,
    2. Miller WL

    . Doing qualitative research, 2nd ed. Thousand Oaks, CA: Sage Publications; 1999.
40. 40.↵
    Centers for Medicare and Medicaid Services. CMS finalizes 2016 Medicare payment rules for physicians, hospitals & other providers,” October 30, 2015 [press release]. Available from: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015–10-30.html. Accessed October 31, 2015.
41. 41.↵
    1. Glaudemans JJ,
    2. Moll van Charante EP,
    3. Willems DL

    . Advance care planning in primary care, only for severely ill patients? A structured review. Fam Pract 2015;32:16–26.

    OpenUrlAbstract/FREE Full Text
42. 42.↵
    National Committee for Quality Assurance. PCMH 2011–PCMH 2014 crosswalk. Available from: http://www.ncqa.org/programs/recognition/practices/patient-centered-medical-home-pcmh/pcmh-2011-pcmh-2014-crosswalk. Accessed May 8, 2016.
43. 43.↵
    1. Riley SB

    . Improving diabetes outcomes by an innovative group visit model: a pilot study. J Am Assoc Nurse Pract 2013;25:466–72.

    OpenUrl
44. 44.↵
    1. May SG,
    2. Cheng PH,
    3. Tietbohl CK,
    4. et al

    . Shared medical appointments to screen for geriatric syndromes: preliminary data from a quality improvement initiative. J Am Geriatr Soc 2014;62:2415–9.

    OpenUrlPubMed
45. 45.↵
    1. Tieu C,
    2. Chaudhry R,
    3. Schroeder DR,
    4. Bock FA,
    5. Hanson GJ,
    6. Tung EE

    . Utilization of patient electronic messaging to promote advance care planning in the primary care setting. Am J Hosp Palliat Care 2016 Jan 1 [Epub ahead of print]. https://dx.doi.org/10.1177/1049909116650237.
46. 46.↵
    1. Kruse CS,
    2. Bolton K,
    3. Freriks G

    . The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review. J Med Internet Res 2015;17:e44.

    OpenUrlCrossRefPubMed