What Do You Think?

Pew Research surveys found in 1990 that 12 percent of Americans
had a “living will,” a figure that rose to just 29 percent by 2005. So on a
nearly daily basis, the palliative care specialist Dr. Joshua Lakin said in an
interview, “I’d see someone who’d had lung cancer for several years, who’d been
in and out of the hospital, had seen 20 doctors, and still hadn’t thought about
the future and his priorities. It kind of blindsided me.” So Dr. Lakin, who
just completed a fellowship at the University of California, San Francisco, and
some colleagues took an entirely different approach to what is called advance
care planning. They experimented with brib…er, incentivizing doctors. And
whaddya know, it worked. As the team reported in JAMA Internal Medicine last week, the UCSF
Medical Center has an incentive program to improve quality; each year its
doctors-in-training pick one area to focus on. For the 2011-2012 academic year,
the internal medicine department decided to concentrate on documenting
patients’ advance care decisions. The researchers came up with a standard form,
which was inserted in patients’ electronic health records. It asked just a few
questions: Does the patient have any “expressed wishes” about how much care he wants
or doesn’t? Where are those preferences recorded — in a living will, a durable
power of attorney, a POLST form (which would be scanned into the record), or
are they expressed orally? The researchers’ form requests a brief summary: He
doesn’t want to be resuscitated or intubated? She wants a feeding tube but not
a ventilator? Or she wants “all available care?” Does he have a designated
decision maker? What is that person’s name and phone number, and what language
does he or she speak? If residents recorded this information for at least 75
percent of discharged patients, for three of the four quarters in the academic
year, they each got a $400 bonus. If not, they didn’t. By October, following
Marketing 101, the proportion of patients with documented preferences hit 90
percent and stayed there. By contrast, a separate team of attending physicians
who didn’t participate in the incentive program averaged less than 12 percent
for the year.

Source/more: New York Times

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