Oregon Health & Science University
ADVANCE-PC: Testing Critical Components for a Trial of Advance Care Planning in Primary Care for Dementia
Health Care Systems
Practice-Based Research Networks within Meta-LARC
Dr. Totten is an associate professor in the Department of Medical Informatics & Clinical Epidemiology at the OHSU School of Medicine and teaches in Public Health Practice program in the OHSU-PSU School of Public Health. Her research interests include aging, chronic disease, long-term services and supports, shared decision making, and research methods. Dr. Totten conducts primary research in related to serious illness, advance care planning, and aging in a network of US and Canadian primary care Practice Based Research Networks (PBRNs) and directs systematic reviews and projects to develop clinical practice guides for a range of topics at the Pacific Northwest Evidence based Practice Center.
RATIONALE: Engaging people living with dementia (PLWD) and their families in advance care planning (ACP) can help assure that health care promotes their wellbeing and aligns with their overall goals, preferences and values. However, primary care clinicians need the skills and support to successfully conduct and incorporate ACP for PLWD into practice workflows.
OBJECTIVE: To establish the feasibility of a conducting a pragmatic clinical trial to evaluate the effectiveness of technology-based tele-mentoring model, the ADVANCE-PC program, to improve ACP for PLWD in diverse primary care practices.
SETTING: Six primary care practices in two practice-based research networks included in the Meta-LARC consortium.
POPULATION: Primary care clinicians caring for PLWD and their families.
INTERVENTION: ADVANCE-PC is a remote tele-mentoring program based on the ECHO model, which uses communication technology to provide facilitated education, case review, and peer-to-peer problem solving.
OUTCOMES: The primary clinical outcome is the proportion of PWLD and/or their care partners cared for by participating clinicians who engaged in ACP ascertained from the clinics’ electronic health records. The pilot study will also assess the success of program implementation using several measures including, clinicians’ participation, acceptability of program, and ACP documentation.
IMPACT: This pilot study will inform the design of a large-scale pragmatic trial of the ADVANCE-PC program in multiple, diverse primary care practices. A scalable ADVANCE-PC program has the potential to assure that ACP becomes routine in primary care for PLWD and their families, thereby promoting alignment of care with their goals and preferences.