Improving Care for Patients with Advanced Kidney Disease: More, Earlier and Better Conversations Using the Serious Illness Conversation Guide (QI639)

Abstract

•Describe the deficits in advance care planning and goals of care conversations among patients with advanced kidney disease.•Measure the impact of implementing the Serious Illness Conversation & Care Planning Program among a group of nephrologists.•Disseminate lessons learned and future directions for ongoing implementation of the Serious Illness Conversation & Care Planning Program within a nephrology practice. Despite growing evidence citing benefits, advance care planning (ACP) conversations and advance directive (AD) completion remain low in patients with advanced kidney disease. This quality improvement project aimed to improve quality of conversations and AD completion in this patient population at a large healthcare system. Baylor Scott & White Health (BSWH), in partnership with Ariadne Labs (AL), is implementing the Serious Illness Conversation and Care Planning Program (SICP). Physicians and Advance Practice Professionals are trained to use the Serious Illness Conversation Guide (SIG) through a training program created by AL and taught by trained faculty at BSWH. We collected baseline data prior to training. Data is collected from the conversation guide which was built into multiple electronic medical record (EMR) systems. Review of aggregate data is ongoing for implementation process improvement. Approximately 1% of patients within a nephrology practice had ADs retrievable in the EMR in 2015. Information about patient preferences for care were unable to be obtained from the documentation, therefore timing of conversations before death could not be calculated. As of June 2018, 21 nephrologists have been trained and 51 conversations documented across all CKD clinics in system. Of these, 35 (68%) included answers to the understanding question, shared prognosis and made a recommendation. Conversations led to creating a new AD in 14 patients (27%). To date, four patients died (7%) and four were admitted to hospice (7%). The average time from conversation to death was 158.5 days. Approximately 15 nephrologists are scheduled for training in the next 3 months. Evaluations of the course revealed nephrologists found the training useful and recommend it to others. After completing SIG training, nephrologists engaged in more and earlier conversations and completed more ADs. Nephrologists found the training helpful and would recommend to others.