Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
J Am Geriatr Soc. 2024 Oct;72(10):3022-3034. doi: 10.1111/jgs.19100. Epub 2024 Jul 23.
serious illness conversations (SIC), particularly for persons living with cognitive impairment (PLCI), inconsistently happen in primary care. Pragmatic, scalable strategies are needed to promote SIC for PLCI.
Pragmatic, prospective single-arm pilot study that occurred between July 1, 2021 and May 30, 2022 across seven primary care practices in North Carolina.
Community-dwelling patients aged 65 and older with known or probable mild cognitive impairment or dementia (with decision-making capacity) and their care partners (if available).
SIC telehealth intervention (TeleVoice) via video or telephone to assist PLCI in discussing their current goals, values, and future medical preferences, while facilitating documentation within the EHR.
Main feasibility outcomes included reach/enrollment, intervention completion, and adoption rates at the clinic and provider level. Primary effectiveness outcomes included SIC documentation and quality within the EHR and usage of advance care planning billing (ACP) codes.
Of the 163 eligible PLCI approached, 107 (66%) enrolled (mean age 83.7 years, 68.2% female, 16.8% Black, 22% living in a geographic area of high socioeconomic disadvantage) and 81 (76%) completed the SIC telehealth intervention; 45 care partners agreed to participate (mean age 71.5 years, 80% female). Adoption at clinic level was 50%, while 75% of providers within these clinics participated. Among PLCI that completed the intervention, SIC documentation and usage of ACP billing codes was 100% and 96%, respectively, with 96% (n = 78) having high-quality SIC documentation. No significant differences were observed between telephone and video visits.
These findings provide preliminary evidence to support the feasibility of conducting SICs through telehealth to specifically meet the needs of community-dwelling PLCI. Further investigation of the sustainability of the intervention and its long-term impact on patient and caregiver outcomes is needed.
严重疾病对话（SIC），特别是对于认知障碍（PLCI）患者，在初级保健中不一致地发生。需要实用且可扩展的策略来促进 PLCI 的 SIC。
2021 年 7 月 1 日至 2022 年 5 月 30 日，在北卡罗来纳州的 7 个初级保健实践中进行了实用的前瞻性单臂试点研究。
社区居住的 65 岁及以上的患者，患有已知或可能的轻度认知障碍或痴呆症（有决策能力）及其护理伙伴（如果有）。
通过视频或电话进行 SIC 远程医疗干预（TeleVoice），以帮助 PLCI 讨论其当前的目标、价值观和未来的医疗偏好，同时促进 EHR 中的文档记录。
主要可行性结果包括覆盖面/入组、干预完成率和诊所及提供者层面的采用率。主要有效性结果包括 EHR 中的 SIC 文档记录和质量以及使用预先护理计划计费（ACP）代码。
在 163 名符合条件的 PLCI 中，有 107 名（66%）入组（平均年龄 83.7 岁，68.2%为女性，16.8%为黑人，22%生活在社会经济劣势较高的地区），81 名（76%）完成了 SIC 远程医疗干预；45 名护理伙伴同意参与（平均年龄 71.5 岁，80%为女性）。诊所层面的采用率为 50%，而这些诊所的 75%的提供者参与了研究。在完成干预的 PLCI 中，SIC 文档记录和 ACP 计费代码的使用率分别为 100%和 96%，96%（n=78）的 SIC 文档记录质量较高。电话和视频访问之间没有观察到显著差异。
这些发现提供了初步证据，支持通过远程医疗进行 SIC 的可行性，特别是满足社区居住的 PLCI 的需求。需要进一步研究该干预措施的可持续性及其对患者和护理人员结局的长期影响。
