Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement

Kimberly K. Garner, Patricia Dubbert, Shelly Lensing, Dennis H. Sullivan, Rebecca A. Aslakson, Katherine Ast, Ronit Elk, Kimberly K. Garner, Robert Gramling, Corita Grudzen, Arif H. Kamal, Sangeeta Lamba, Thomas W. LeBlanc, Ramona L. Rhodes, Eric Roeland, Dena Schulman-Green, Kathleen T. Unroe

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Context The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. Objectives To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. Methods Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. Results Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences. Conclusions Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers.

Original languageEnglish (US)
Pages (from-to)1-4
Number of pages4
JournalJournal of Pain and Symptom Management
Volume53
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Veterans
Advance Directives
Documentation
Self Report
Primary Health Care
Electronic Health Records
Ambulatory Care
Advance Care Planning
Hospices
Health Personnel
Communication

Keywords

  • advance care planning
  • advance directive
  • communication
  • palliative care
  • quality improvement
  • quality indicators
  • Surrogate decision maker

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers : Implications for Quality Measurement. / Garner, Kimberly K.; Dubbert, Patricia; Lensing, Shelly; Sullivan, Dennis H.; Aslakson, Rebecca A.; Ast, Katherine; Elk, Ronit; Garner, Kimberly K.; Gramling, Robert; Grudzen, Corita; Kamal, Arif H.; Lamba, Sangeeta; LeBlanc, Thomas W.; Rhodes, Ramona L.; Roeland, Eric; Schulman-Green, Dena; Unroe, Kathleen T.

In: Journal of Pain and Symptom Management, Vol. 53, No. 1, 01.01.2017, p. 1-4.

Research output: Contribution to journalArticle

Garner, KK, Dubbert, P, Lensing, S, Sullivan, DH, Aslakson, RA, Ast, K, Elk, R, Garner, KK, Gramling, R, Grudzen, C, Kamal, AH, Lamba, S, LeBlanc, TW, Rhodes, RL, Roeland, E, Schulman-Green, D & Unroe, KT 2017, 'Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement', Journal of Pain and Symptom Management, vol. 53, no. 1, pp. 1-4. https://doi.org/10.1016/j.jpainsymman.2016.10.356
Garner, Kimberly K. ; Dubbert, Patricia ; Lensing, Shelly ; Sullivan, Dennis H. ; Aslakson, Rebecca A. ; Ast, Katherine ; Elk, Ronit ; Garner, Kimberly K. ; Gramling, Robert ; Grudzen, Corita ; Kamal, Arif H. ; Lamba, Sangeeta ; LeBlanc, Thomas W. ; Rhodes, Ramona L. ; Roeland, Eric ; Schulman-Green, Dena ; Unroe, Kathleen T. / Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers : Implications for Quality Measurement. In: Journal of Pain and Symptom Management. 2017 ; Vol. 53, No. 1. pp. 1-4.
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abstract = "Context The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. Objectives To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. Methods Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. Results Of veterans without a documented AD on file, more than half (66{\%}) reported that they had talked with someone they trusted and nearly half (52{\%}) reported that they had named someone to communicate their preferences. Conclusions Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers.",
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N2 - Context The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. Objectives To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. Methods Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. Results Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences. Conclusions Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers.

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