Anna Kata1, Rebecca Sudore1,2, Emily Finlayson1,3, Jeanette M Broering4, Sarah Ngo1,2, Victoria L Tang1,5. 1. Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California. 2. Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, California. 3. Department of Surgery, University of California, San Francisco, California. 4. Department of Urology, University of California, San Francisco, California. 5. Division of Hospital Medicine, Department of Medicine, Veterans Affairs Medical Center, San Francisco, California.
Abstract
OBJECTIVES: To describe an innovative model of care, the Surgery Wellness Program (SWP), that uses a multidisciplinary team to develop and implement preoperative care plans for older adults, and its effect on engagement in advance care planning (ACP). DESIGN: Retrospective analysis of clinical demonstration project. SETTING: Preoperative optimization program for older adults undergoing surgery at a 796-bed academic tertiary hospital. PARTICIPANTS: Older adults (N=131) who participated in the SWP from February 2015 to August 2017. INTERVENTION: All SWP participants met with a geriatrician who engaged them in a semistructured ACP discussion. Trained medical and nurse practitioner students were used as health coaches who contacted participants regularly to address and document ACP. MEASUREMENTS: Self-report of ACP engagement before and after participation in the SWP was determined using SWP geriatrician and health coach progress notes. Medical records were examined for scanned documentation. Feasibility data on number of health coach calls were collected. RESULTS: After completion of the program, the proportion of participants with a designated surrogate increased from 67% to 78% (p<.001), completed advance directive (AD) from 51% to 72% (p<.001), and an AD scanned into the medical record from 14% to 60% (p<.001). Participants who underwent surgery received a median of 4 health coaching calls over a median of 27 days between their clinic visit and surgery. Case examples are presented to highlight how the SWP attends to the many components of the ACP process. CONCLUSION: Preoperative optimization programs provide a unique opportunity to engage older adults in ACP.
OBJECTIVES: To describe an innovative model of care, the Surgery Wellness Program (SWP), that uses a multidisciplinary team to develop and implement preoperative care plans for older adults, and its effect on engagement in advance care planning (ACP). DESIGN: Retrospective analysis of clinical demonstration project. SETTING: Preoperative optimization program for older adults undergoing surgery at a 796-bed academic tertiary hospital. PARTICIPANTS: Older adults (N=131) who participated in the SWP from February 2015 to August 2017. INTERVENTION: All SWP participants met with a geriatrician who engaged them in a semistructured ACP discussion. Trained medical and nurse practitioner students were used as health coaches who contacted participants regularly to address and document ACP. MEASUREMENTS: Self-report of ACP engagement before and after participation in the SWP was determined using SWP geriatrician and health coach progress notes. Medical records were examined for scanned documentation. Feasibility data on number of health coach calls were collected. RESULTS: After completion of the program, the proportion of participants with a designated surrogate increased from 67% to 78% (p<.001), completed advance directive (AD) from 51% to 72% (p<.001), and an AD scanned into the medical record from 14% to 60% (p<.001). Participants who underwent surgery received a median of 4 health coaching calls over a median of 27 days between their clinic visit and surgery. Case examples are presented to highlight how the SWP attends to the many components of the ACP process. CONCLUSION: Preoperative optimization programs provide a unique opportunity to engage older adults in ACP.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Rebecca L Sudore; John Boscardin; Mariko A Feuz; Ryan D McMahan; Mary T Katen; Deborah E Barnes Journal: JAMA Intern Med Date: 2017-08-01 Impact factor: 21.873
Authors: Valerie A Lawrence; Helen P Hazuda; John E Cornell; Thomas Pederson; Patrick T Bradshaw; Cynthia D Mulrow; Carey P Page Journal: J Am Coll Surg Date: 2004-11 Impact factor: 6.113
Authors: Anthony D Yang; David J Bentrem; Sam G Pappas; Elizabeth Amundsen; James E Ward; Michael B Ujiki; Peter Angelos Journal: Am J Surg Date: 2004-07 Impact factor: 2.565
Authors: Anna Kata; Meghan Dutt; Rebecca L Sudore; Emily Finlayson; Jeanette M Broering; Victoria L Tang Journal: J Am Geriatr Soc Date: 2019-08-10 Impact factor: 5.562
Authors: Lisa Cooper; Yusi Gong; Aaron R Dezube; Emanuele Mazzola; Ashley L Deeb; Clark Dumontier; Michael T Jaklitsch; Laura N Frain Journal: J Surg Oncol Date: 2022-03-25 Impact factor: 2.885
Authors: Elle L Kalbfell; Anne Buffington; Anna Kata; Karen J Brasel; Anne C Mosenthal; Zara Cooper; Emily Finlayson; Margaret L Schwarze Journal: Am J Surg Date: 2021-06-15 Impact factor: 3.125