NYU Langone tackles end-of-life care decision-making

Dr. Jonathan Austrian, medical director, Inpatient Clinical Informatics, at NYU Langone Health.

NYU Langone Health developed an end-of-life clinical decision support care initiative for shared decision-making among patients, their families and the care team.

Launched in 2017, the Respecting Choices Person-Centered Care Model improves care by aligning the goals of the patient and the care team.

"Understanding and documenting patients' goals, values, and preferences helps ensure our care teams are always providing care that aligns with the patient's wishes," said Dr. Jonathan Austrian, medical director, Inpatient Clinical Informatics, at NYU Langone Health.

End-of-life care is a tough subject for physicians, patients and their families. Providers have long known that care at the end of life can be enormously expensive, and may not reflect a patient's wishes.

Medicare has estimated that 25 percent of its annual spending is used by 5 percent of patients during the last year of their lives.

NYU Langone wanted to change the culture around end-of-life discussions. First, it needed a way to identify those patients who would benefit from advance care planning conversations.

The health system developed a bundle of clinical decision support interventions to promote screening, identification, and appropriate care of patients with limited life expectancy. 

The model has improved screening by 34 percent and care plan documentation by 71 percent.

"NYU Langone Health invested heavily in changing the culture before creating our required screening program," Austrian said.

Members of the care team received education to increase their capacity for providing this type of care.

NYU Langone embedded a provider facing screening question into the EHR admission process that was cosigned on admission and at discharge by the attending of record. Patients screening positive triggered decision support for palliative care consults and completion of other best practices for high-risk patients.

All documentation related to goals of care was curated in a specific activity to ensure transparency to all members of the care team.

"We employ a combination of solutions to help identify patients who could benefit from palliative services," Austrian said.

Providers are required to answer direct screening question for all their patients including: "Would you be surprised if the patient dies in the next six months?"

In addition, NYU Langone created a machine learning model that predicts short-term mortality and alerts the patient's attending of record and its supportive care team.

Austrian and Glenn Doty, senior director, MCIT Clinical Systems and Clinical Transformation at NYU Langone Health, will present "Promoting End-of-Life Advanced Care Planning Using Health IT," from 11:30 a.m. to 12:30 p.m., Thursday, Feb. 14, room 315B, Orange County Convention Center, during HIMSS19 in Orlando, Florida.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com