Structured advanced care planning facilitated by case managers.

Abstract

142 Background: Although advanced care planning facilitates end-of-life decisions, less than half of severely or terminally ill patients have completed an advanced care plan. Accordingly, Humana launched a pilot of care manager-facilitated structured advanced care planning discussions among individuals with complex chronic conditions, including cancer. Process metrics were reviewed to determine whether the pilot would be scalable to a larger population. Methods: The pilot included two groups, 1) high-severity patients who had been receiving long term in-home care management for ≥30 days with a high comorbidity burden, and 2) functionally-challenged patients who had been receiving telephonic care management for ≥30 days and had a moderate comorbidity burden. Twenty care managers participated in 2 live and 9 virtual training sessions on the structured discussion approach. Care managers documented the following process metrics: number and length of structured advanced care planning discussions, number of advanced directives completed or updated, and number of times hospice services were reviewed. Results: Among the 169 high-severity patients in home settings, structured discussions occurred with 54.4% of the population, and 20.1% either updated or completed an advanced directive. Among the 106 functionally challenged patients receiving telephonic care management, 37.7% had structured discussions, and 13.2% either updated or completed an advanced directive. Hospice services were reviewed with 23.6% of the high-severity patients, and 3.7% of the functionally-challenged patients. The amount of time spent by the care managers was longer for the home consultations (average=15.1 minutes) compared to the telephonic consultations (average=10.24 minutes). Conclusions: In this pilot, a higher percentage of advanced care discussions were completed with high-severity patients receiving home care management than functionally-challenged patients receiving telephonic care management. The differences could be attributed many variables, including the health state or setting. This pilot was determined not to be scalable to a broader population, and alternative approaches for advanced care planning currently being evaluated.