Outcomes of a 3-Year Quality Improvement Study to Improve Advance Care Planning in Patients With Decompensated Cirrhosis

Arpan Patel; Chip A Bowman; Nicole Prause; Saikiran M Kilaru; Andrew Nguyen; Nina Kogekar; Cynthia Cohen; Lindsay Channen; Alyson Harty; Ponni Perumalswami; Douglas Dietrich; Thomas Schiano; Christopher Woodrell; Ritu Agarwal

doi:10.14309/ajg.0000000000002570

Outcomes of a 3-Year Quality Improvement Study to Improve Advance Care Planning in Patients With Decompensated Cirrhosis

Am J Gastroenterol. 2024 Mar 1;119(3):580-583. doi: 10.14309/ajg.0000000000002570. Epub 2023 Nov 7.

Authors

Arpan Patel^{1

2}, Chip A Bowman³, Nicole Prause¹, Saikiran M Kilaru⁴, Andrew Nguyen⁵, Nina Kogekar⁶, Cynthia Cohen⁷, Lindsay Channen⁸, Alyson Harty⁹, Ponni Perumalswami¹⁰, Douglas Dietrich⁹, Thomas Schiano¹¹, Christopher Woodrell^{12

13}, Ritu Agarwal⁹

Affiliations

¹ Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
² Department of Gastroenterology, Hepatology, and Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
³ Division of Digestive and Liver Diseases, Department of Medicine, Columbia University New York Presbyterian Hospital, New York, New York, USA.
⁴ Division of Gastroenterology and Hepatology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
⁵ Department of Gastroenterology and Hepatology, Kaiser Permanente Washington, Seattle, Washington, USA.
⁶ Division of Gastroenterology, Montefiore Medical Center, Bronx, New York, USA.
⁷ Division of Gastroenterology and Hepatology, Westchester Medical Center.
⁸ Warren Alpert Medical School of Brown University in Providence, Providence, Rhode Island, USA.
⁹ Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹⁰ Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
¹¹ Recanati Miller Transplant Institute, Mount Sinai Hospital, New York, New York, USA.
¹² Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹³ Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.

Abstract

Introduction: To report outcomes of a 3-year quality improvement pilot study to improve advance directive (AD) completion.

Methods: The pilot consisted of champions, education, electronic health record templates, and workflow changes. We assessed changes, predictors, and effects of AD completion.

Results: The pilot led to greater (8.3%-36%) and earlier AD completion, particularly among those divorced, with alcohol-associated liver disease, and with higher Model of End-Stage Liver Disease-Sodium score. Decedents whose AD specified nonaggressive goals experienced lower hospital lengths of stay.

Discussion: Advance care planning initiatives are feasible and may reduce health care utilization among decedents requesting less aggressive care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Advance Care Planning*
Aged
Female
Humans
Length of Stay / statistics & numerical data
Liver Cirrhosis* / therapy
Male
Middle Aged
Pilot Projects
Quality Improvement*

Grants and funding

AASLDF 50035/American Association for the Study of Liver Diseases