Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY...
Transcript of Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY...
![Page 1: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/1.jpg)
PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER)
Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor of Emergency
Medicine and Population Health
Ronald O. Perelman Department of
Emergency Medicine
![Page 2: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/2.jpg)
![Page 3: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/3.jpg)
• Window to population health
• Research agenda to end disparities, & address the needs of society’s most vulnerable
Emergency Care
![Page 4: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/4.jpg)
• Increasing ED visits by older adults with serious illness
• Most prefer to receive care at home and to minimize life-sustaining procedures
• Palliative care improves quality of life and decrease health care use
Background
![Page 5: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/5.jpg)
Default Approach
![Page 6: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/6.jpg)
Goal of PRIM-ER: provider and system change
![Page 7: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/7.jpg)
1. Evidence-based, multidisciplinary primary palliative care education (EPEC-EM,
ELNEC);
2. Simulation-based workshops on communication in serious illness (EM Talk);
3. Clinical decision support; and
4. Provider audit and feedback.
PRIM-ER Intervention Components
![Page 8: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/8.jpg)
1. Identify and prepare champions
2. Incentives
3. Audit and feedback
4. Learning collaborative
5. System & organizational changes
– Clinical decision support
– Referral systems and workflow
Implementation Strategies
![Page 9: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/9.jpg)
18 Health Systems
![Page 10: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/10.jpg)
Cluster Randomized, Stepped Wedge Trial @ 35 EDs
![Page 11: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/11.jpg)
![Page 12: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/12.jpg)
Over 30 Physician and Nurse Champions Trained
![Page 13: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/13.jpg)
76 Emergency Providers and 100 Nurses trained @ 2 pilot sites
![Page 14: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/14.jpg)
![Page 15: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/15.jpg)
Clinical Decision Support @ NYU Langone
Function 1. Identify seriously ill patients with advance care
planning documents
![Page 16: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/16.jpg)
Function 2. Identify patients on hospice.
![Page 17: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/17.jpg)
Function 3. Refer patients to interdisciplinary services.
![Page 18: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/18.jpg)
Function 4. Initiate goals of care conversation.
![Page 19: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/19.jpg)
Audit and Feedback Dashboard @ NYU Langone
![Page 20: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/20.jpg)
Usability Testing: ED Process Map
![Page 21: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/21.jpg)
Tailoring Clinical Decision Support to Each Site
![Page 22: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/22.jpg)
UG3 Milestones Accomplished
Milestone
IRB Approval ✓
Commitment from Sites ✓
Recruitment of MD and RN Champions ✓
Finalized Statistical Data Analysis and Methods ✓
Finalized Intervention Protocol ✓
Finalized DSMP ✓
All 17 Subcontracts finalized ✓
Tailored interventions at each individual site ✓
![Page 23: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/23.jpg)
Additional UG3 Milestones Accomplished
Milestone
Develop, test usability, and deploy clinical decision support at NYU
Perelman✓
Develop and deploy audit and feedback dashboard at NYU Perelman ✓
Clinical Decision Support Live at NYU and Rutgers ✓
Deploy EM Talk at NYU and Rutgers with at least 75% participation ✓
Deploy ELNEC Training Modules online for nurses ✓
Distributed Randomization Schedule and outline ✓
Completed all 18 Site Visits to discuss implementation ✓
![Page 24: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/24.jpg)
Next Steps
![Page 25: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/25.jpg)
Ronald O. Perelman Department of Emergency Medicine25
![Page 26: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/26.jpg)
If you want to go fast, go alone.
If you want to go far, go together.
African Proverb
![Page 27: Primary Palliative Care for Emergency Medicine (PRIM-ER)PRIMARY PALLIATIVE CARE FOR EMERGENCY MEDICINE (PRIM-ER) Corita Grudzen, MD, MSHS, Vice Chair for Research, Associate Professor](https://reader030.fdocuments.us/reader030/viewer/2022040300/5e6bd87758bea966f3446218/html5/thumbnails/27.jpg)
THANK YOU