IMPROVING THE HEALTH CARE PROXY APPOINTMENT BY A SIMPLE TEAM APPROACH
Abstract
Objective: To increase the rate of health care proxy by identifying the factors affecting signed Health care proxy (HCP) in the chart at NewYork Presbyterian Brooklyn Methodist Hospital.
Method: A prospective study was designed and discussed with the team of office manager, Physician, physician assistant, medical assistant, and a research fellow. The physician facilitated HCP discussion and education. Each patient was provided with the Health care proxy form, and while in the exam room, was given a separate time and encounter with the research fellow who would provide them with the information and questionnaire throughout 60 days and address their concerns. If the patient agreed, then the form would be signed by the patient and two witnesses and scanned in the system, Cerner Millennium under “outpatient advance directive” tab to ensure easy tracking. Data were collected through the report and analyzed for diversity and success.
Results: A total of 212 patients attended the outpatient clinic for the physician involved over 60 days of the initial implementation of the study. Based on her availability, the research fellow interacted with 106 patients and provided education regarding health care proxy and addressed their questions and concerns about the appointment of a proxy. 73 patients out of 106 were willing and completed health care proxy forms and thereby appointed a proxy. Thirteen patients admitted to completion of health care proxy by next visit. Thirteen patients already had a proxy selected. There was no statistical significance in a proxy appointment for the following factors:
Age, Sex, Race, Religion, Education level, Marital status.
However, our intervention of educating the patients about the health care proxy produced a p-value of less than 0.0001.
Conclusions: Appropriate planning, a creative workflow, dedicated time, and counseling by a skilled person can lead to successful Health care proxy implementation. Initiating a conversation from the provider side contributes to the removal of a patient hesitation about the discussion on advance care planning with the provider.
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