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Ways Of Increasing Overall Completion Rates In The Healthcare System

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A stakeholder may be defined as those bodies that are fundamentally involved in the healthcare system and would be impacted by system reforms to include patients, physicians, employers, insurance companies, pharmaceutical firms and government. The stakeholders for this study project will include the patient, clinic staff, providers, administration staff and family members/care-givers.

Understanding provider-patient barriers to completing ADs, as well as understanding why some patients choose to (or not to) complete ADs is an important step in increasing overall completion rates. Spoelhof and Elliot (2012) looked at some of the barriers to improving completion rates in the primary care setting. Barriers specific to the provider perspective included lack of institutional support, lack of time and reimbursement, and discomfort with the topic. Patient specific barriers included fear of burdening one’s family, health literacy, as well as spiritual, cultural and racial traditions. In some cases, elderly patients did not have an option for a reliable proxy due to family estrangement, their loved ones were deceased, or in situations where the individual never had children. In these instances, the Physician Orders for Life-Sustaining Treatment (POLST) form proved to be most important, allowing patients to direct their end-of-life care in the absence of a reliable proxy and encourage providers to engage in AD/end of life discussions with their patients.

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The healthcare facility/employers, in conjunction with the healthcare regulatory bodies may better support this effort by allocating adequate time and pecuniary resources to further incentivize and support the efforts of the providers that are providing AD services to their patients, as well as absorb the anticipated administrative costs associated with providing these services to patients. This project will impact staff by adding additional responsibilities and documentation requirements for the administrative staff and primary care providers.

The process of gaining support is a way of obtaining valuable information. In pragmatic terms, the medical assistants and providers will be convened and asked to provide input for desired system changes as well as participate in planning and implementation of the project tasks. Relevant/focused education is an effective strategy for fostering acceptance of practice changes. Educational presentations and one-on-one information sharing sessions will be utilized as supportive measures for the staff as well as utilized as an opportunity to foster acceptance of the practice changes. This strategy may also be employed to expand patient understanding, promote informed decision making, and facilitate a more comprehensive patient-provider collaboration and AD compliance by the empowered patient. Patients who choose not to participate may be encouraged to provide signed declination forms that will be entered into their patient encounter records.

Administration of pre and post questionnaires before and after the education sessions may be a valuable strategy for assessing and determining the comfort level of allied staff and providers. This initiative will further ensure that the education sessions are better streamlined towards equipping and empowering the stakeholders with the relevant skillset required to becoming more comfortable in approaching conversations about ADs. In listening to other presenters, the individual may be afforded the opportunity to review and realign his/her plan or ideas that are not in alignment with the mission, vision, and goal of the AD project. A strategy to promote and increase awareness of the AD project by some stakeholders (notably the clinical /administrative staff) may involve the propagation and widest dissemination of the progress reports and outcomes of the quality improvement project to all invested parties and the public. In alignment with the Diffusion of Innovations Theory, planned periodical celebrations for successes achieved with the implementation of the care bundle intervention and outcomes may also be promoted.

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